Risk factors for stroke in children and their relationship to outcome were determined by reviewing charts of 72 patients with ischemic and hemorrhagic strokes at the Universities of Montreal and Toronto, Canada. Of 51 with ischemic strokes, 46 were arterial and 5 sinovenous thromboses. Risk factors were variable and multiple in 24% of the 51 with ischemic stroke. Ischemic stroke recurred in 8% of patients with a single or no risk factor and in 42% with multiple risk factors (p=0.01). Of 21 with hemorrhagic stroke, none had multiple risk factors, 67% were caused by vascular abnormalities, and 10% recurred. Outcomes in the total 72 patients were as follows: 36% were asymptomatic, 45% had epilepsy or persistent neurologic deficit, and 20% died. Those with recurrent stroke had a greater risk of dying (40%) than those without (16%).

Hematologic and metabolic screening should be a part of the workup of ischemic stroke, even when a cause is known. This should include aPL antibodies, protein C and S antibodies and deficiencies, antithrombin, factor V Leiden, and hyperhomocysteinemia. Other significant risk factors include cardiac abnormalities occurring in 20% of patients with ischemic stroke, vasculopathies (25%), sickle cell disease, and recent or concurrent systemic or intracranial infection and mild head and neck trauma. [1]

COMMENT. Multiple risk factors are common in children with ischemic stroke and may predict stroke recurrence. Mortality increases with stroke recurrence.

Neonatal hemorrhagic stroke. Two variants of temporal lobe infarction are described in 10 neonates treated at Gent University Hospital, Belgium [2]. All except 2 were VLBW infants with hyaline membrane disease. The injury was venous infarction with temporal or para-atrial matrix hemorrhage. Except for one fatal case, intraventricular bleeding was mild to moderate. The lesions were detected by sonography. Survivors scored in the low normal range on the Bayley Mental Development Index; one developed temporal lobe epilepsy.