Death certificate data for ischemic and hemorrhagic stroke (subarachnoid hemorrhage [SAH] and intracerebral’ hemorrhage [ICH] in children under 20 years of age in the United States were analyzed for a 20 year period at the University of California, San Francisco. Whites accounted for 81% of the stroke mortalities, and sexes were equally distributed. There were 4881 deaths from stroke, with an average of 244 per year. Average annual mortality rates were 0.09 per 100,000 person-years for ischemic stroke, 0.14 for ICH, and 0.11 for SAH. Infants under 1 year old had the highest mortality rates of any age group: 0.57 for ischemic stroke, 0.60 for SAH, and 1.04 for ICH. Infants accounted for only 5% of the children, but one third of stroke deaths occurred in infants (35% of ischemic, 30% of SAH, and 39% of ICH stroke deaths). Between the years 1979 through 1998, childhood mortality from stroke declined by 58%, from 0.55 to 0.23/100,000 person-years, with reductions in all major subtypes. Ischemic stroke decreased by 19%; SAH by 79%; and ICH by 54%. Risk factors for mortality included the following: black ethnicity (relative risks for ischemic, SAH, and ICH stroke were 1.74, 1.76, and 2.06, respectively (p<0.0001 for all types); and male sex (relative risks for SAH and ICH were 1.30 and 1.21, respectively (p<0.0001) but not from ischemic stroke (relative risk 1.02 (p=0.76). Compared to adults, death rates for hemorrhagic stroke (ICH and SAH) have declined more among children, whereas death rates for ischemic stroke had dropped twice as much for adults (45%) as for children (19%). [1]

COMMENT. Mortality from stroke in US children has declined by more than 50% over the last 20 years. Infants are particularly susceptible, accounting for one third of stroke deaths in children, black children are at greater risk of death from stroke than white children, and males have a higher mortality rate than females.

Outcome in young adults with ischemic stroke was studied in 287 consecutive patients (15 to 45 years) followed for 3 years by clinical examinations or telephone interviews at the University of Lille, Roger Salengro Hospital, France [2]. The annual mortality rate was 4.5% in the first year and 1.6% in the second and third year follow-up. The annual stroke recurrence rates were 1.4% and 1.0% in the first year and subsequent years, respectively. Epileptic seizures occurred in 6.6% of patients.

In an editorial, Kittner SJ [3] emphasizes the social toll of ischemic stroke described in the above studies of ischemic stroke in young adults: high incidence of divorce and job loss. He discusses the role of homocystinuria and B vitamin deficiency in the cause of vascular disease and stroke, and a genetic contribution to stroke risk, particularly in early-onset cases.

Report of the NIND&S Workshop on perinatal and childhood stroke was published as a special article by Lynch JK et al. Pediatrics Jan 2002;109:109-123. See Ped Neur Briefs March 2002;16:21-22.