The epidemiology, risk factors, outcome and prognosis of perinatal and childhood stroke were reviewed at a workshop sponsored by the National Institute of Neurological Disorders and Stroke in Bethesda, MD, on Sept 18 and 19, 2000. Neonatal stroke occurs in approximately 1/4000 live births per year. Cause is often undetermined, but includes cardiac disorders, infection, blood abnormalities, and <5% associated with birth asphyxia. Coagulation disorders (factor V Leiden and prothrombin mutation, protein C, protein S, and antithrombin III deficiences are identified in 50% of infants and children with cerebral thromboembolism. Maternal factors may also contribute. An abnormal EEG during the first week after stroke is predictive of hemiplegia. Infarction demonstrated by neuroimaging and involving the internal capsule also predicts development of hemiplegia, whereas involvement of other regions is less predictive.

Childhood stroke incidence is estimated at 2-3/100,000 in the USA, and the US mortality rate attributed to stroke in children is 0.6/100,000. Stroke mortality has ranged from 7% to 28%. Causes include thromboembolism, arteriopathy, or are undetermined. Risk factors include cardiac disorders, coagulation disorders, sickle cell disease, infection, moyamoya, and arterial dissection. Up to 30% have postvaricella angiopathy. Sinus venous thrombosis occurs usually in the first year of life, and presents with focal abnormalities and seizures. Risk factors include head and neck infections, dehyration, perinatal complications, and coagulation disorders. Hemorrhagic stroke is less common than ischemic stroke in children. Risk factors include vascular malformation, malignancy, trauma, and coagulation disorders; AVM is the most common cause. The evaluation of stroke in children should include hematologic, metabolic, and angiographic studies. The Canadian Pediatric Stroke Registry (CPISR) outcome data, which includes 402 children with arterial ischemic stroke and 160 with sinus thrombosis, show that 27% are neurologically normal, 61% abnormal, 22% recurred, and a mortality of 12%. [1]

COMMENT. The authors conclude that pediatric stroke registries, similar to the one in Canada, are needed to provide data regarding the impact of maternal and perinatal factors on the causes and outcome of childhood stroke in the US.