Document Detail


Malignant MCA territory infarction in the pediatric population: subgroup analysis of the Greater Cincinnati/Northern Kentucky Stroke Study.
MedLine Citation:
PMID:  22914922     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Malignant middle cerebral artery (MCA) infarctions are thought to be rare in children. In a recent hospital-based study, only 1.3 % of pediatric ischemic strokes were malignant MCA infarctions. However, population-based rates have not been published. We performed subgroup analysis of a population-based study to determine the rate of malignant MCA infarctions in children.
METHODS: In 2005 and 2010, all ischemic stroke-related emergency visits and hospital admissions among the 1.3 million residents of the five-county Greater Cincinnati/Northern Kentucky area were ascertained. Cases that occurred in patients 18 years and younger were reviewed in detail, and corresponding clinical and neuroimaging findings were recorded. Infarctions were considered malignant if they involved 50 % or more of the MCA territory and resulted in cerebral edema and mass effect.
RESULTS: In 2005, eight pediatric ischemic strokes occurred in the study population, none of which were malignant infarctions. In 2010, there were also eight ischemic strokes. Of these, two malignant MCA infarctions were identified: (1) a 7-year-old boy who underwent hemicraniectomy and survived with moderate disability at 30 days and (2) a 17-year-old girl with significant prestroke disability who was not offered hemicraniectomy and died following withdrawal of care. Thus, among 16 children over 2 years, there were two malignant MCA infarctions (12.5 %, 95 % CI 0-29).
CONCLUSIONS: Malignant MCA infarctions in children may not be as rare as previously thought. Given the significant survival and functional outcome benefit conferred by hemicraniectomy in adults, future studies focusing on its potential role in pediatric patients are warranted.
Authors:
Ralph Rahme; Lincoln Jimenez; Umair Bashir; Opeolu M Adeoye; Todd A Abruzzo; Andrew J Ringer; Brett M Kissela; Jane Khoury; Charles J Moomaw; Heidi Sucharew; Simona Ferioli; Matthew L Flaherty; Daniel Woo; Pooja Khatri; Kathleen Alwell; Dawn Kleindorfer
Publication Detail:
Type:  Journal Article     Date:  2012-08-23
Journal Detail:
Title:  Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery     Volume:  29     ISSN:  1433-0350     ISO Abbreviation:  Childs Nerv Syst     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-04     Completed Date:  2013-06-14     Revised Date:  2014-10-18    
Medline Journal Info:
Nlm Unique ID:  8503227     Medline TA:  Childs Nerv Syst     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  99-103     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Child
Child, Preschool
Community Health Planning
Female
Hospitalization / statistics & numerical data
Humans
Infarction, Middle Cerebral Artery / epidemiology*
Kentucky / epidemiology
Male
Ohio / epidemiology
Pediatrics*
Retrospective Studies
Stroke / complications,  epidemiology*,  radiography
Tomography, X-Ray Computed
Grant Support
ID/Acronym/Agency:
R01 NS030678/NS/NINDS NIH HHS; UL1 TR000077/TR/NCATS NIH HHS
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