CHILDHOOD STROKES: EPIDEMIOLOGY, CLINICAL FEATURES AND RISK FACTORS
Abstract
Background: Stroke constitutes a significant health problem in paediatric population. The impactof childhood stroke can easily be realised in terms of economic, social and psychological burden
related to disability of the affected children. The objective of study was to outline the
epidemiology and clinical features of stroke in a cohort of Pakistani children and also ascertain the
causes and potential risk factors in these patients. Methods: The study was conducted at the
Department of Paediatrics, Ayub Teaching Hospital from January 2008 to October 2010. It was a
cross sectional study. A total of 46 patients were included in the study who presented with
cerebrovascular disease and were assessed clinically using general physical and systemic
examination. The salient epidemiological, clinical, neuro-imaging and laboratory data was
retrieved in designed protocol. Results: Out of a total of 46 patients, 50% were from either
gender. Mean age of presentation was 39 months. Limb weakness was the commonest presenting
feature being present in 37 (80.43%) patients. Infectious disorders was the most prevalent risk
factor present in 31 (67.39%) patients followed by microcytic hypochromic anaemia in 28
(60.86%) patients. Conclusion: A Childhood stroke is a disorder with long term morbidity.
Identification of risk factors is important in preventing the disorder by guiding appropriate
interventions.
Keywords: Childhood stroke, Infectious disorders, risk factors
References
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Schoenberg BS, Mellinger JF, Schoenberg DG. Cerebrovascular
disease in infants and children: a study of incidence, clinical
features, and survival. Neurology 1978;28:763-8.
Broderick J, Talbot GT, Prenger E, Leach A, Brott T. Stroke in
children within a major metropolitan area: the surprising
importance of intracerebral hemorrhage. J Child Neurol 1993;8
:250-5.
Giroud M, Lemesle M, Gouyon KB, Nivelon JL, Milan C,
Dumas R. Cerebrovascular disease in children under 16 years of
age in the city of Dijon, France: a study of incidence and clinical
features from 1985 to 1993. J Clin Epidemiol 1995;48:1343- 8.
Salih MA, Abdel-Gader AM, Al-Jarallah AA, Kentab AY,
Alorainy IA, Hassan HH, et al. Stroke in Saudi children:
Epidemiology, clinical features and risk factors. Saudi Med J
;27 Suppl 1:S1220.
Max JE, Robin DA, Taylor HG, Yeates KO, Fox PT, Lancaster
JL, et al. Attention function after childhood stroke. J Int
Neuropsychol Soc 2004;10:97686.
Lanni G, Catalucci A, Conti L, Di Sibio A, Paonessa A, Gallucci
M. Pediatric Stroke: Clinical Findings and Radiological
Approach. Stroke Res Treat 2011;2011:172168. Epub 2011
Apr 19.
Bendixen BH, Passner J, Lango R. Stroke in young adults and
children. Current Neurol Neurosci Rep 2001;1:5466.
Garcia JH, Pantoni L. Strokes in childhood. Semin Pediatr
Neurol 1995;2(3):18091.
Fullerton HJ, Wu YW, Sidney S, Johnston SC. Risk of recurrent
childhood arterial ischemic stroke in a population-based cohort:
The importance of cerebrovascular imaging. Pediatrics.
;119:495-501.
Strater R, Vielhaber H, Kassenbohmer R, von Kries R, Gobel U,
Nowak-Gottl U. Genetic risk factors of thrombophilia in
ischaemic childhood stroke of cardiac origin. A prospective
ESPED survey. Eur J Pediatr 1999;158 Suppl 3:S122-5.
Nowak-Gottl U, Strater R, Heinecke A, Junker R, Koch HG,
Schuierer G, et al. Lipoprotein (a) and genetic polymorphisms of
clotting factor V, prothrombin, and methylenetetrahydrofolate
reductase are risk factors of spontaneous ischemic stroke in
childhood. Blood 1999;94(11):367882.
Takeoka M, Takahashi T. Infectious and inflammatory disorders
of the circulatory system and stroke in childhood. Curr Opin
Neurol 2002;15(2):15964.
Sanchetee P. Stroke and central nervous system infections. J
Indian Med Assoc 2009;107(6):3727.
Bowen MD, Burak CR, Barron TF. Childhood ischemic stroke in
non urban population. J Child Neurol 2005;20:1947.
Herguner MO, Incecik F, Elkay M, Altunbasak S, Baytok V.
Evaluation of 39 children with stroke regarding etiologic risk
factors and treatment. Turk J Paediatr 2005;47:1169.
Steinlin R, Pfister I, Pavlovic J, Everts R, Boltshauser E, Capone
Mori A, et al. The first 3 years of the Swiss Neuropediatric
Stroke Register (SNPSR): A Population Based Study Of
Incidence, Symptoms And risk factors. Neuropediatrics
;36:907.
Salih MA, Zahraa JN, Al-Jarallah AA, Alorainy IA, Hassan HH.
Stroke from systemic vascular disorders in Saudi children. The
devastating role of hypernatremic dehydration. Saudi Med J
;27 Suppl 1:S97102.
Garcia JC, Roach ES, McLean WT. Recurrent thrombotic
deterioration in Sturge Weber Syndrome. Childs
Brain1981;8:42733.
Huang J, McGirt MJ, Gailloud P, Tamargo RJ. Intracranial
aneurysms in the pediatric population: case series and literature
review. Surg Neurol 2005;63(5):42433.
Sheikh BY, Hassounah M, Al-Moutare K, Ammar A, Enazi A.
Childhood intracranial arteriovenous malformation in Saudi
Arabia. Childs Nerv Syst 1999;15(5):2626.
Walsh LE, Garg BP. Ischemic strokes in children. Indian J
Pediatr 1997;64(5):61323.
de V eber G. The Canadian Pediatric ischemic stroke study
group. Canadian pediatric ischemic stroke registry: analysis of
children with arterial ischemic stroke. Ann Neurol 2000;48:526.
Tham EH, Tay SK, Low PS. Factors predictive of outcome in
childhood stroke in an Asian population. Ann Acad Med
Singapore 2009;38(10):87681.
Ganesan V, Prengler M, Mc Shana MA, Wade AM, Kirkham FJ.
Investigation of risk factors in children with arterial ischemic
stroke. Ann Neurol 2003;53(2):16773.
Address for Correspondence:
Dr. Saima Bibi, Senior Lecturer, Department of Physiology, Ayub Medical College, Abbottabad-22040, Pakistan.
Cell: +92-300-5635010
Email: drsaima79@yahoo.com6.
Schoenberg BS, Mellinger JF, Schoenberg DG. Cerebrovascular
disease in infants and children: a study of incidence, clinical
features, and survival. Neurology 1978;28:763-8.
Broderick J, Talbot GT, Prenger E, Leach A, Brott T. Stroke in
children within a major metropolitan area: the surprising
importance of intracerebral hemorrhage. J Child Neurol 1993;8
:250-5.
Giroud M, Lemesle M, Gouyon KB, Nivelon JL, Milan C,
Dumas R. Cerebrovascular disease in children under 16 years of
age in the city of Dijon, France: a study of incidence and clinical
features from 1985 to 1993. J Clin Epidemiol 1995;48:1343- 8.
Salih MA, Abdel-Gader AM, Al-Jarallah AA, Kentab AY,
Alorainy IA, Hassan HH, et al. Stroke in Saudi children:
Epidemiology, clinical features and risk factors. Saudi Med J
;27 Suppl 1:S1220.
Max JE, Robin DA, Taylor HG, Yeates KO, Fox PT, Lancaster
JL, et al. Attention function after childhood stroke. J Int
Neuropsychol Soc 2004;10:97686.
Lanni G, Catalucci A, Conti L, Di Sibio A, Paonessa A, Gallucci
M. Pediatric Stroke: Clinical Findings and Radiological
Approach. Stroke Res Treat 2011;2011:172168. Epub 2011
Apr 19.
Bendixen BH, Passner J, Lango R. Stroke in young adults and
children. Current Neurol Neurosci Rep 2001;1:5466.
Garcia JH, Pantoni L. Strokes in childhood. Semin Pediatr
Neurol 1995;2(3):18091.
Fullerton HJ, Wu YW, Sidney S, Johnston SC. Risk of recurrent
childhood arterial ischemic stroke in a population-based cohort:
The importance of cerebrovascular imaging. Pediatrics.
;119:495-501.
Strater R, Vielhaber H, Kassenbohmer R, von Kries R, Gobel U,
Nowak-Gottl U. Genetic risk factors of thrombophilia in
ischaemic childhood stroke of cardiac origin. A prospective
ESPED survey. Eur J Pediatr 1999;158 Suppl 3:S122-5.
Nowak-Gottl U, Strater R, Heinecke A, Junker R, Koch HG,
Schuierer G, et al. Lipoprotein (a) and genetic polymorphisms of
clotting factor V, prothrombin, and methylenetetrahydrofolate
reductase are risk factors of spontaneous ischemic stroke in
childhood. Blood 1999;94(11):367882.
Takeoka M, Takahashi T. Infectious and inflammatory disorders
of the circulatory system and stroke in childhood. Curr Opin
Neurol 2002;15(2):15964.
Sanchetee P. Stroke and central nervous system infections. J
Indian Med Assoc 2009;107(6):3727.
Bowen MD, Burak CR, Barron TF. Childhood ischemic stroke in
non urban population. J Child Neurol 2005;20:1947.
Herguner MO, Incecik F, Elkay M, Altunbasak S, Baytok V.
Evaluation of 39 children with stroke regarding etiologic risk
factors and treatment. Turk J Paediatr 2005;47:1169.
Steinlin R, Pfister I, Pavlovic J, Everts R, Boltshauser E, Capone
Mori A, et al. The first 3 years of the Swiss Neuropediatric
Stroke Register (SNPSR): A Population Based Study Of
Incidence, Symptoms And risk factors. Neuropediatrics
;36:907.
Salih MA, Zahraa JN, Al-Jarallah AA, Alorainy IA, Hassan HH.
Stroke from systemic vascular disorders in Saudi children. The
devastating role of hypernatremic dehydration. Saudi Med J
;27 Suppl 1:S97102.
Garcia JC, Roach ES, McLean WT. Recurrent thrombotic
deterioration in Sturge Weber Syndrome. Childs
Brain1981;8:42733.
Huang J, McGirt MJ, Gailloud P, Tamargo RJ. Intracranial
aneurysms in the pediatric population: case series and literature
review. Surg Neurol 2005;63(5):42433.
Sheikh BY, Hassounah M, Al-Moutare K, Ammar A, Enazi A.
Childhood intracranial arteriovenous malformation in Saudi
Arabia. Childs Nerv Syst 1999;15(5):2626.
Walsh LE, Garg BP. Ischemic strokes in children. Indian J
Pediatr 1997;64(5):61323.
de V eber G. The Canadian Pediatric ischemic stroke study
group. Canadian pediatric ischemic stroke registry: analysis of
children with arterial ischemic stroke. Ann Neurol 2000;48:526.
Tham EH, Tay SK, Low PS. Factors predictive of outcome in
childhood stroke in an Asian population. Ann Acad Med
Singapore 2009;38(10):87681.
Ganesan V, Prengler M, Mc Shana MA, Wade AM, Kirkham FJ.
Investigation of risk factors in children with arterial ischemic
stroke. Ann Neurol 2003;53(2):16773.
Address for Correspondence:
Dr. Saima Bibi, Senior Lecturer, Department of Physiology, Ayub Medical College, Abbottabad-22040, Pakistan.
Cell: +92-300-5635010
Email: drsaima79@yahoo.com20.
Max JE, Robin DA, Taylor HG, Yeates KO, Fox PT, Lancaster
JL, et al. Attention function after childhood stroke. J Int
Neuropsychol Soc 2004;10:97686.
Lanni G, Catalucci A, Conti L, Di Sibio A, Paonessa A, Gallucci
M. Pediatric Stroke: Clinical Findings and Radiological
Approach. Stroke Res Treat 2011;2011:172168. Epub 2011
Apr 19.
Bendixen BH, Passner J, Lango R. Stroke in young adults and
children. Current Neurol Neurosci Rep 2001;1:5466.
Garcia JH, Pantoni L. Strokes in childhood. Semin Pediatr
Neurol 1995;2(3):18091.
Fullerton HJ, Wu YW, Sidney S, Johnston SC. Risk of recurrent
childhood arterial ischemic stroke in a population-based cohort:
The importance of cerebrovascular imaging. Pediatrics.
;119:495-501.
Strater R, Vielhaber H, Kassenbohmer R, von Kries R, Gobel U,
Nowak-Gottl U. Genetic risk factors of thrombophilia in
ischaemic childhood stroke of cardiac origin. A prospective
ESPED survey. Eur J Pediatr 1999;158 Suppl 3:S122-5.
Nowak-Gottl U, Strater R, Heinecke A, Junker R, Koch HG,
Schuierer G, et al. Lipoprotein (a) and genetic polymorphisms of
clotting factor V, prothrombin, and methylenetetrahydrofolate
reductase are risk factors of spontaneous ischemic stroke in
childhood. Blood 1999;94(11):367882.
Takeoka M, Takahashi T. Infectious and inflammatory disorders
of the circulatory system and stroke in childhood. Curr Opin
Neurol 2002;15(2):15964.
Sanchetee P. Stroke and central nervous system infections. J
Indian Med Assoc 2009;107(6):3727.
Bowen MD, Burak CR, Barron TF. Childhood ischemic stroke in
non urban population. J Child Neurol 2005;20:1947.
Herguner MO, Incecik F, Elkay M, Altunbasak S, Baytok V.
Evaluation of 39 children with stroke regarding etiologic risk
factors and treatment. Turk J Paediatr 2005;47:1169.
Steinlin R, Pfister I, Pavlovic J, Everts R, Boltshauser E, Capone
Mori A, et al. The first 3 years of the Swiss Neuropediatric
Stroke Register (SNPSR): A Population Based Study Of
Incidence, Symptoms And risk factors. Neuropediatrics
;36:907.
Salih MA, Zahraa JN, Al-Jarallah AA, Alorainy IA, Hassan HH.
Stroke from systemic vascular disorders in Saudi children. The
devastating role of hypernatremic dehydration. Saudi Med J
;27 Suppl 1:S97102.
Garcia JC, Roach ES, McLean WT. Recurrent thrombotic
deterioration in Sturge Weber Syndrome. Childs
Brain1981;8:42733.
Huang J, McGirt MJ, Gailloud P, Tamargo RJ. Intracranial
aneurysms in the pediatric population: case series and literature
review. Surg Neurol 2005;63(5):42433.
Sheikh BY, Hassounah M, Al-Moutare K, Ammar A, Enazi A.
Childhood intracranial arteriovenous malformation in Saudi
Arabia. Childs Nerv Syst 1999;15(5):2626.
Walsh LE, Garg BP. Ischemic strokes in children. Indian J
Pediatr 1997;64(5):61323.
de V eber G. The Canadian Pediatric ischemic stroke study
group. Canadian pediatric ischemic stroke registry: analysis of
children with arterial ischemic stroke. Ann Neurol 2000;48:526.
Tham EH, Tay SK, Low PS. Factors predictive of outcome in
childhood stroke in an Asian population. Ann Acad Med
Singapore 2009;38(10):87681.
Ganesan V, Prengler M, Mc Shana MA, Wade AM, Kirkham FJ.
Investigation of risk factors in children with arterial ischemic
stroke. Ann Neurol 2003;53(2):16773.
Address for Correspondence:
Dr. Saima Bibi, Senior Lecturer, Department of Physiology, Ayub Medical College, Abbottabad-22040, Pakistan.
Cell: +92-300-5635010
Email: drsaima79@yahoo.com86.
Lanni G, Catalucci A, Conti L, Di Sibio A, Paonessa A, Gallucci
M. Pediatric Stroke: Clinical Findings and Radiological
Approach. Stroke Res Treat 2011;2011:172168. Epub 2011
Apr 19.
Bendixen BH, Passner J, Lango R. Stroke in young adults and
children. Current Neurol Neurosci Rep 2001;1:5466.
Garcia JH, Pantoni L. Strokes in childhood. Semin Pediatr
Neurol 1995;2(3):18091.
Fullerton HJ, Wu YW, Sidney S, Johnston SC. Risk of recurrent
childhood arterial ischemic stroke in a population-based cohort:
The importance of cerebrovascular imaging. Pediatrics.
;119:495-501.
Strater R, Vielhaber H, Kassenbohmer R, von Kries R, Gobel U,
Nowak-Gottl U. Genetic risk factors of thrombophilia in
ischaemic childhood stroke of cardiac origin. A prospective
ESPED survey. Eur J Pediatr 1999;158 Suppl 3:S122-5.
Nowak-Gottl U, Strater R, Heinecke A, Junker R, Koch HG,
Schuierer G, et al. Lipoprotein (a) and genetic polymorphisms of
clotting factor V, prothrombin, and methylenetetrahydrofolate
reductase are risk factors of spontaneous ischemic stroke in
childhood. Blood 1999;94(11):367882.
Takeoka M, Takahashi T. Infectious and inflammatory disorders
of the circulatory system and stroke in childhood. Curr Opin
Neurol 2002;15(2):15964.
Sanchetee P. Stroke and central nervous system infections. J
Indian Med Assoc 2009;107(6):3727.
Bowen MD, Burak CR, Barron TF. Childhood ischemic stroke in
non urban population. J Child Neurol 2005;20:1947.
Herguner MO, Incecik F, Elkay M, Altunbasak S, Baytok V.
Evaluation of 39 children with stroke regarding etiologic risk
factors and treatment. Turk J Paediatr 2005;47:1169.
Steinlin R, Pfister I, Pavlovic J, Everts R, Boltshauser E, Capone
Mori A, et al. The first 3 years of the Swiss Neuropediatric
Stroke Register (SNPSR): A Population Based Study Of
Incidence, Symptoms And risk factors. Neuropediatrics
;36:907.
Salih MA, Zahraa JN, Al-Jarallah AA, Alorainy IA, Hassan HH.
Stroke from systemic vascular disorders in Saudi children. The
devastating role of hypernatremic dehydration. Saudi Med J
;27 Suppl 1:S97102.
Garcia JC, Roach ES, McLean WT. Recurrent thrombotic
deterioration in Sturge Weber Syndrome. Childs
Brain1981;8:42733.
Huang J, McGirt MJ, Gailloud P, Tamargo RJ. Intracranial
aneurysms in the pediatric population: case series and literature
review. Surg Neurol 2005;63(5):42433.
Sheikh BY, Hassounah M, Al-Moutare K, Ammar A, Enazi A.
Childhood intracranial arteriovenous malformation in Saudi
Arabia. Childs Nerv Syst 1999;15(5):2626.
Walsh LE, Garg BP. Ischemic strokes in children. Indian J
Pediatr 1997;64(5):61323.
de V eber G. The Canadian Pediatric ischemic stroke study
group. Canadian pediatric ischemic stroke registry: analysis of
children with arterial ischemic stroke. Ann Neurol 2000;48:526.
Tham EH, Tay SK, Low PS. Factors predictive of outcome in
childhood stroke in an Asian population. Ann Acad Med
Singapore 2009;38(10):87681.
Ganesan V, Prengler M, Mc Shana MA, Wade AM, Kirkham FJ.
Investigation of risk factors in children with arterial ischemic
stroke. Ann Neurol 2003;53(2):16773.
Address for Correspondence:
Dr. Saima Bibi, Senior Lecturer, Department of Physiology, Ayub Medical College, Abbottabad-22040, Pakistan.
Cell: +92-300-5635010
Email: drsaima79@yahoo.com66.
Garcia JH, Pantoni L. Strokes in childhood. Semin Pediatr
Neurol 1995;2(3):18091.
Fullerton HJ, Wu YW, Sidney S, Johnston SC. Risk of recurrent
childhood arterial ischemic stroke in a population-based cohort:
The importance of cerebrovascular imaging. Pediatrics.
;119:495-501.
Strater R, Vielhaber H, Kassenbohmer R, von Kries R, Gobel U,
Nowak-Gottl U. Genetic risk factors of thrombophilia in
ischaemic childhood stroke of cardiac origin. A prospective
ESPED survey. Eur J Pediatr 1999;158 Suppl 3:S122-5.
Nowak-Gottl U, Strater R, Heinecke A, Junker R, Koch HG,
Schuierer G, et al. Lipoprotein (a) and genetic polymorphisms of
clotting factor V, prothrombin, and methylenetetrahydrofolate
reductase are risk factors of spontaneous ischemic stroke in
childhood. Blood 1999;94(11):367882.
Takeoka M, Takahashi T. Infectious and inflammatory disorders
of the circulatory system and stroke in childhood. Curr Opin
Neurol 2002;15(2):15964.
Sanchetee P. Stroke and central nervous system infections. J
Indian Med Assoc 2009;107(6):3727.
Bowen MD, Burak CR, Barron TF. Childhood ischemic stroke in
non urban population. J Child Neurol 2005;20:1947.
Herguner MO, Incecik F, Elkay M, Altunbasak S, Baytok V.
Evaluation of 39 children with stroke regarding etiologic risk
factors and treatment. Turk J Paediatr 2005;47:1169.
Steinlin R, Pfister I, Pavlovic J, Everts R, Boltshauser E, Capone
Mori A, et al. The first 3 years of the Swiss Neuropediatric
Stroke Register (SNPSR): A Population Based Study Of
Incidence, Symptoms And risk factors. Neuropediatrics
;36:907.
Salih MA, Zahraa JN, Al-Jarallah AA, Alorainy IA, Hassan HH.
Stroke from systemic vascular disorders in Saudi children. The
devastating role of hypernatremic dehydration. Saudi Med J
;27 Suppl 1:S97102.
Garcia JC, Roach ES, McLean WT. Recurrent thrombotic
deterioration in Sturge Weber Syndrome. Childs
Brain1981;8:42733.
Huang J, McGirt MJ, Gailloud P, Tamargo RJ. Intracranial
aneurysms in the pediatric population: case series and literature
review. Surg Neurol 2005;63(5):42433.
Sheikh BY, Hassounah M, Al-Moutare K, Ammar A, Enazi A.
Childhood intracranial arteriovenous malformation in Saudi
Arabia. Childs Nerv Syst 1999;15(5):2626.
Walsh LE, Garg BP. Ischemic strokes in children. Indian J
Pediatr 1997;64(5):61323.
de V eber G. The Canadian Pediatric ischemic stroke study
group. Canadian pediatric ischemic stroke registry: analysis of
children with arterial ischemic stroke. Ann Neurol 2000;48:526.
Tham EH, Tay SK, Low PS. Factors predictive of outcome in
childhood stroke in an Asian population. Ann Acad Med
Singapore 2009;38(10):87681.
Ganesan V, Prengler M, Mc Shana MA, Wade AM, Kirkham FJ.
Investigation of risk factors in children with arterial ischemic
stroke. Ann Neurol 2003;53(2):16773.
Address for Correspondence:
Dr. Saima Bibi, Senior Lecturer, Department of Physiology, Ayub Medical College, Abbottabad-22040, Pakistan.
Cell: +92-300-5635010
Email: drsaima79@yahoo.com91.
Fullerton HJ, Wu YW, Sidney S, Johnston SC. Risk of recurrent
childhood arterial ischemic stroke in a population-based cohort:
The importance of cerebrovascular imaging. Pediatrics.
;119:495-501.
Strater R, Vielhaber H, Kassenbohmer R, von Kries R, Gobel U,
Nowak-Gottl U. Genetic risk factors of thrombophilia in
ischaemic childhood stroke of cardiac origin. A prospective
ESPED survey. Eur J Pediatr 1999;158 Suppl 3:S122-5.
Nowak-Gottl U, Strater R, Heinecke A, Junker R, Koch HG,
Schuierer G, et al. Lipoprotein (a) and genetic polymorphisms of
clotting factor V, prothrombin, and methylenetetrahydrofolate
reductase are risk factors of spontaneous ischemic stroke in
childhood. Blood 1999;94(11):367882.
Takeoka M, Takahashi T. Infectious and inflammatory disorders
of the circulatory system and stroke in childhood. Curr Opin
Neurol 2002;15(2):15964.
Sanchetee P. Stroke and central nervous system infections. J
Indian Med Assoc 2009;107(6):3727.
Bowen MD, Burak CR, Barron TF. Childhood ischemic stroke in
non urban population. J Child Neurol 2005;20:1947.
Herguner MO, Incecik F, Elkay M, Altunbasak S, Baytok V.
Evaluation of 39 children with stroke regarding etiologic risk
factors and treatment. Turk J Paediatr 2005;47:1169.
Steinlin R, Pfister I, Pavlovic J, Everts R, Boltshauser E, Capone
Mori A, et al. The first 3 years of the Swiss Neuropediatric
Stroke Register (SNPSR): A Population Based Study Of
Incidence, Symptoms And risk factors. Neuropediatrics
;36:907.
Salih MA, Zahraa JN, Al-Jarallah AA, Alorainy IA, Hassan HH.
Stroke from systemic vascular disorders in Saudi children. The
devastating role of hypernatremic dehydration. Saudi Med J
;27 Suppl 1:S97102.
Garcia JC, Roach ES, McLean WT. Recurrent thrombotic
deterioration in Sturge Weber Syndrome. Childs
Brain1981;8:42733.
Huang J, McGirt MJ, Gailloud P, Tamargo RJ. Intracranial
aneurysms in the pediatric population: case series and literature
review. Surg Neurol 2005;63(5):42433.
Sheikh BY, Hassounah M, Al-Moutare K, Ammar A, Enazi A.
Childhood intracranial arteriovenous malformation in Saudi
Arabia. Childs Nerv Syst 1999;15(5):2626.
Walsh LE, Garg BP. Ischemic strokes in children. Indian J
Pediatr 1997;64(5):61323.
de V eber G. The Canadian Pediatric ischemic stroke study
group. Canadian pediatric ischemic stroke registry: analysis of
children with arterial ischemic stroke. Ann Neurol 2000;48:526.
Tham EH, Tay SK, Low PS. Factors predictive of outcome in
childhood stroke in an Asian population. Ann Acad Med
Singapore 2009;38(10):87681.
Ganesan V, Prengler M, Mc Shana MA, Wade AM, Kirkham FJ.
Investigation of risk factors in children with arterial ischemic
stroke. Ann Neurol 2003;53(2):16773.
Address for Correspondence:
Dr. Saima Bibi, Senior Lecturer, Department of Physiology, Ayub Medical College, Abbottabad-22040, Pakistan.
Cell: +92-300-5635010
Email: drsaima79@yahoo.com82.
Takeoka M, Takahashi T. Infectious and inflammatory disorders
of the circulatory system and stroke in childhood. Curr Opin
Neurol 2002;15(2):15964.
Sanchetee P. Stroke and central nervous system infections. J
Indian Med Assoc 2009;107(6):3727.
Bowen MD, Burak CR, Barron TF. Childhood ischemic stroke in
non urban population. J Child Neurol 2005;20:1947.
Herguner MO, Incecik F, Elkay M, Altunbasak S, Baytok V.
Evaluation of 39 children with stroke regarding etiologic risk
factors and treatment. Turk J Paediatr 2005;47:1169.
Steinlin R, Pfister I, Pavlovic J, Everts R, Boltshauser E, Capone
Mori A, et al. The first 3 years of the Swiss Neuropediatric
Stroke Register (SNPSR): A Population Based Study Of
Incidence, Symptoms And risk factors. Neuropediatrics
;36:907.
Salih MA, Zahraa JN, Al-Jarallah AA, Alorainy IA, Hassan HH.
Stroke from systemic vascular disorders in Saudi children. The
devastating role of hypernatremic dehydration. Saudi Med J
;27 Suppl 1:S97102.
Garcia JC, Roach ES, McLean WT. Recurrent thrombotic
deterioration in Sturge Weber Syndrome. Childs
Brain1981;8:42733.
Huang J, McGirt MJ, Gailloud P, Tamargo RJ. Intracranial
aneurysms in the pediatric population: case series and literature
review. Surg Neurol 2005;63(5):42433.
Sheikh BY, Hassounah M, Al-Moutare K, Ammar A, Enazi A.
Childhood intracranial arteriovenous malformation in Saudi
Arabia. Childs Nerv Syst 1999;15(5):2626.
Walsh LE, Garg BP. Ischemic strokes in children. Indian J
Pediatr 1997;64(5):61323.
de V eber G. The Canadian Pediatric ischemic stroke study
group. Canadian pediatric ischemic stroke registry: analysis of
children with arterial ischemic stroke. Ann Neurol 2000;48:526.
Tham EH, Tay SK, Low PS. Factors predictive of outcome in
childhood stroke in an Asian population. Ann Acad Med
Singapore 2009;38(10):87681.
Ganesan V, Prengler M, Mc Shana MA, Wade AM, Kirkham FJ.
Investigation of risk factors in children with arterial ischemic
stroke. Ann Neurol 2003;53(2):16773.
Address for Correspondence:
Dr. Saima Bibi, Senior Lecturer, Department of Physiology, Ayub Medical College, Abbottabad-22040, Pakistan.
Cell: +92-300-5635010
Email: drsaima79@yahoo.com64.
Sanchetee P. Stroke and central nervous system infections. J
Indian Med Assoc 2009;107(6):3727.
Bowen MD, Burak CR, Barron TF. Childhood ischemic stroke in
non urban population. J Child Neurol 2005;20:1947.
Herguner MO, Incecik F, Elkay M, Altunbasak S, Baytok V.
Evaluation of 39 children with stroke regarding etiologic risk
factors and treatment. Turk J Paediatr 2005;47:1169.
Steinlin R, Pfister I, Pavlovic J, Everts R, Boltshauser E, Capone
Mori A, et al. The first 3 years of the Swiss Neuropediatric
Stroke Register (SNPSR): A Population Based Study Of
Incidence, Symptoms And risk factors. Neuropediatrics
;36:907.
Salih MA, Zahraa JN, Al-Jarallah AA, Alorainy IA, Hassan HH.
Stroke from systemic vascular disorders in Saudi children. The
devastating role of hypernatremic dehydration. Saudi Med J
;27 Suppl 1:S97102.
Garcia JC, Roach ES, McLean WT. Recurrent thrombotic
deterioration in Sturge Weber Syndrome. Childs
Brain1981;8:42733.
Huang J, McGirt MJ, Gailloud P, Tamargo RJ. Intracranial
aneurysms in the pediatric population: case series and literature
review. Surg Neurol 2005;63(5):42433.
Sheikh BY, Hassounah M, Al-Moutare K, Ammar A, Enazi A.
Childhood intracranial arteriovenous malformation in Saudi
Arabia. Childs Nerv Syst 1999;15(5):2626.
Walsh LE, Garg BP. Ischemic strokes in children. Indian J
Pediatr 1997;64(5):61323.
de V eber G. The Canadian Pediatric ischemic stroke study
group. Canadian pediatric ischemic stroke registry: analysis of
children with arterial ischemic stroke. Ann Neurol 2000;48:526.
Tham EH, Tay SK, Low PS. Factors predictive of outcome in
childhood stroke in an Asian population. Ann Acad Med
Singapore 2009;38(10):87681.
Ganesan V, Prengler M, Mc Shana MA, Wade AM, Kirkham FJ.
Investigation of risk factors in children with arterial ischemic
stroke. Ann Neurol 2003;53(2):16773.
Address for Correspondence:
Dr. Saima Bibi, Senior Lecturer, Department of Physiology, Ayub Medical College, Abbottabad-22040, Pakistan.
Cell: +92-300-5635010
Email: drsaima79@yahoo.com7.
Bowen MD, Burak CR, Barron TF. Childhood ischemic stroke in
non urban population. J Child Neurol 2005;20:1947.
Herguner MO, Incecik F, Elkay M, Altunbasak S, Baytok V.
Evaluation of 39 children with stroke regarding etiologic risk
factors and treatment. Turk J Paediatr 2005;47:1169.
Steinlin R, Pfister I, Pavlovic J, Everts R, Boltshauser E, Capone
Mori A, et al. The first 3 years of the Swiss Neuropediatric
Stroke Register (SNPSR): A Population Based Study Of
Incidence, Symptoms And risk factors. Neuropediatrics
;36:907.
Salih MA, Zahraa JN, Al-Jarallah AA, Alorainy IA, Hassan HH.
Stroke from systemic vascular disorders in Saudi children. The
devastating role of hypernatremic dehydration. Saudi Med J
;27 Suppl 1:S97102.
Garcia JC, Roach ES, McLean WT. Recurrent thrombotic
deterioration in Sturge Weber Syndrome. Childs
Brain1981;8:42733.
Huang J, McGirt MJ, Gailloud P, Tamargo RJ. Intracranial
aneurysms in the pediatric population: case series and literature
review. Surg Neurol 2005;63(5):42433.
Sheikh BY, Hassounah M, Al-Moutare K, Ammar A, Enazi A.
Childhood intracranial arteriovenous malformation in Saudi
Arabia. Childs Nerv Syst 1999;15(5):2626.
Walsh LE, Garg BP. Ischemic strokes in children. Indian J
Pediatr 1997;64(5):61323.
de V eber G. The Canadian Pediatric ischemic stroke study
group. Canadian pediatric ischemic stroke registry: analysis of
children with arterial ischemic stroke. Ann Neurol 2000;48:526.
Tham EH, Tay SK, Low PS. Factors predictive of outcome in
childhood stroke in an Asian population. Ann Acad Med
Singapore 2009;38(10):87681.
Ganesan V, Prengler M, Mc Shana MA, Wade AM, Kirkham FJ.
Investigation of risk factors in children with arterial ischemic
stroke. Ann Neurol 2003;53(2):16773.
Address for Correspondence:
Dr. Saima Bibi, Senior Lecturer, Department of Physiology, Ayub Medical College, Abbottabad-22040, Pakistan.
Cell: +92-300-5635010
Email: drsaima79@yahoo.com7.
Herguner MO, Incecik F, Elkay M, Altunbasak S, Baytok V.
Evaluation of 39 children with stroke regarding etiologic risk
factors and treatment. Turk J Paediatr 2005;47:1169.
Steinlin R, Pfister I, Pavlovic J, Everts R, Boltshauser E, Capone
Mori A, et al. The first 3 years of the Swiss Neuropediatric
Stroke Register (SNPSR): A Population Based Study Of
Incidence, Symptoms And risk factors. Neuropediatrics
;36:907.
Salih MA, Zahraa JN, Al-Jarallah AA, Alorainy IA, Hassan HH.
Stroke from systemic vascular disorders in Saudi children. The
devastating role of hypernatremic dehydration. Saudi Med J
;27 Suppl 1:S97102.
Garcia JC, Roach ES, McLean WT. Recurrent thrombotic
deterioration in Sturge Weber Syndrome. Childs
Brain1981;8:42733.
Huang J, McGirt MJ, Gailloud P, Tamargo RJ. Intracranial
aneurysms in the pediatric population: case series and literature
review. Surg Neurol 2005;63(5):42433.
Sheikh BY, Hassounah M, Al-Moutare K, Ammar A, Enazi A.
Childhood intracranial arteriovenous malformation in Saudi
Arabia. Childs Nerv Syst 1999;15(5):2626.
Walsh LE, Garg BP. Ischemic strokes in children. Indian J
Pediatr 1997;64(5):61323.
de V eber G. The Canadian Pediatric ischemic stroke study
group. Canadian pediatric ischemic stroke registry: analysis of
children with arterial ischemic stroke. Ann Neurol 2000;48:526.
Tham EH, Tay SK, Low PS. Factors predictive of outcome in
childhood stroke in an Asian population. Ann Acad Med
Singapore 2009;38(10):87681.
Ganesan V, Prengler M, Mc Shana MA, Wade AM, Kirkham FJ.
Investigation of risk factors in children with arterial ischemic
stroke. Ann Neurol 2003;53(2):16773.
Address for Correspondence:
Dr. Saima Bibi, Senior Lecturer, Department of Physiology, Ayub Medical College, Abbottabad-22040, Pakistan.
Cell: +92-300-5635010
Email: drsaima79@yahoo.com9.
Steinlin R, Pfister I, Pavlovic J, Everts R, Boltshauser E, Capone
Mori A, et al. The first 3 years of the Swiss Neuropediatric
Stroke Register (SNPSR): A Population Based Study Of
Incidence, Symptoms And risk factors. Neuropediatrics
;36:907.
Salih MA, Zahraa JN, Al-Jarallah AA, Alorainy IA, Hassan HH.
Stroke from systemic vascular disorders in Saudi children. The
devastating role of hypernatremic dehydration. Saudi Med J
;27 Suppl 1:S97102.
Garcia JC, Roach ES, McLean WT. Recurrent thrombotic
deterioration in Sturge Weber Syndrome. Childs
Brain1981;8:42733.
Huang J, McGirt MJ, Gailloud P, Tamargo RJ. Intracranial
aneurysms in the pediatric population: case series and literature
review. Surg Neurol 2005;63(5):42433.
Sheikh BY, Hassounah M, Al-Moutare K, Ammar A, Enazi A.
Childhood intracranial arteriovenous malformation in Saudi
Arabia. Childs Nerv Syst 1999;15(5):2626.
Walsh LE, Garg BP. Ischemic strokes in children. Indian J
Pediatr 1997;64(5):61323.
de V eber G. The Canadian Pediatric ischemic stroke study
group. Canadian pediatric ischemic stroke registry: analysis of
children with arterial ischemic stroke. Ann Neurol 2000;48:526.
Tham EH, Tay SK, Low PS. Factors predictive of outcome in
childhood stroke in an Asian population. Ann Acad Med
Singapore 2009;38(10):87681.
Ganesan V, Prengler M, Mc Shana MA, Wade AM, Kirkham FJ.
Investigation of risk factors in children with arterial ischemic
stroke. Ann Neurol 2003;53(2):16773.
Address for Correspondence:
Dr. Saima Bibi, Senior Lecturer, Department of Physiology, Ayub Medical College, Abbottabad-22040, Pakistan.
Cell: +92-300-5635010
Email: drsaima79@yahoo.com7.
Salih MA, Zahraa JN, Al-Jarallah AA, Alorainy IA, Hassan HH.
Stroke from systemic vascular disorders in Saudi children. The
devastating role of hypernatremic dehydration. Saudi Med J
;27 Suppl 1:S97102.
Garcia JC, Roach ES, McLean WT. Recurrent thrombotic
deterioration in Sturge Weber Syndrome. Childs
Brain1981;8:42733.
Huang J, McGirt MJ, Gailloud P, Tamargo RJ. Intracranial
aneurysms in the pediatric population: case series and literature
review. Surg Neurol 2005;63(5):42433.
Sheikh BY, Hassounah M, Al-Moutare K, Ammar A, Enazi A.
Childhood intracranial arteriovenous malformation in Saudi
Arabia. Childs Nerv Syst 1999;15(5):2626.
Walsh LE, Garg BP. Ischemic strokes in children. Indian J
Pediatr 1997;64(5):61323.
de V eber G. The Canadian Pediatric ischemic stroke study
group. Canadian pediatric ischemic stroke registry: analysis of
children with arterial ischemic stroke. Ann Neurol 2000;48:526.
Tham EH, Tay SK, Low PS. Factors predictive of outcome in
childhood stroke in an Asian population. Ann Acad Med
Singapore 2009;38(10):87681.
Ganesan V, Prengler M, Mc Shana MA, Wade AM, Kirkham FJ.
Investigation of risk factors in children with arterial ischemic
stroke. Ann Neurol 2003;53(2):16773.
Address for Correspondence:
Dr. Saima Bibi, Senior Lecturer, Department of Physiology, Ayub Medical College, Abbottabad-22040, Pakistan.
Cell: +92-300-5635010
Email: drsaima79@yahoo.com102.
Garcia JC, Roach ES, McLean WT. Recurrent thrombotic
deterioration in Sturge Weber Syndrome. Childs
Brain1981;8:42733.
Huang J, McGirt MJ, Gailloud P, Tamargo RJ. Intracranial
aneurysms in the pediatric population: case series and literature
review. Surg Neurol 2005;63(5):42433.
Sheikh BY, Hassounah M, Al-Moutare K, Ammar A, Enazi A.
Childhood intracranial arteriovenous malformation in Saudi
Arabia. Childs Nerv Syst 1999;15(5):2626.
Walsh LE, Garg BP. Ischemic strokes in children. Indian J
Pediatr 1997;64(5):61323.
de V eber G. The Canadian Pediatric ischemic stroke study
group. Canadian pediatric ischemic stroke registry: analysis of
children with arterial ischemic stroke. Ann Neurol 2000;48:526.
Tham EH, Tay SK, Low PS. Factors predictive of outcome in
childhood stroke in an Asian population. Ann Acad Med
Singapore 2009;38(10):87681.
Ganesan V, Prengler M, Mc Shana MA, Wade AM, Kirkham FJ.
Investigation of risk factors in children with arterial ischemic
stroke. Ann Neurol 2003;53(2):16773.
Address for Correspondence:
Dr. Saima Bibi, Senior Lecturer, Department of Physiology, Ayub Medical College, Abbottabad-22040, Pakistan.
Cell: +92-300-5635010
Email: drsaima79@yahoo.com33.
Huang J, McGirt MJ, Gailloud P, Tamargo RJ. Intracranial
aneurysms in the pediatric population: case series and literature
review. Surg Neurol 2005;63(5):42433.
Sheikh BY, Hassounah M, Al-Moutare K, Ammar A, Enazi A.
Childhood intracranial arteriovenous malformation in Saudi
Arabia. Childs Nerv Syst 1999;15(5):2626.
Walsh LE, Garg BP. Ischemic strokes in children. Indian J
Pediatr 1997;64(5):61323.
de V eber G. The Canadian Pediatric ischemic stroke study
group. Canadian pediatric ischemic stroke registry: analysis of
children with arterial ischemic stroke. Ann Neurol 2000;48:526.
Tham EH, Tay SK, Low PS. Factors predictive of outcome in
childhood stroke in an Asian population. Ann Acad Med
Singapore 2009;38(10):87681.
Ganesan V, Prengler M, Mc Shana MA, Wade AM, Kirkham FJ.
Investigation of risk factors in children with arterial ischemic
stroke. Ann Neurol 2003;53(2):16773.
Address for Correspondence:
Dr. Saima Bibi, Senior Lecturer, Department of Physiology, Ayub Medical College, Abbottabad-22040, Pakistan.
Cell: +92-300-5635010
Email: drsaima79@yahoo.com33.
Sheikh BY, Hassounah M, Al-Moutare K, Ammar A, Enazi A.
Childhood intracranial arteriovenous malformation in Saudi
Arabia. Childs Nerv Syst 1999;15(5):2626.
Walsh LE, Garg BP. Ischemic strokes in children. Indian J
Pediatr 1997;64(5):61323.
de V eber G. The Canadian Pediatric ischemic stroke study
group. Canadian pediatric ischemic stroke registry: analysis of
children with arterial ischemic stroke. Ann Neurol 2000;48:526.
Tham EH, Tay SK, Low PS. Factors predictive of outcome in
childhood stroke in an Asian population. Ann Acad Med
Singapore 2009;38(10):87681.
Ganesan V, Prengler M, Mc Shana MA, Wade AM, Kirkham FJ.
Investigation of risk factors in children with arterial ischemic
stroke. Ann Neurol 2003;53(2):16773.
Address for Correspondence:
Dr. Saima Bibi, Senior Lecturer, Department of Physiology, Ayub Medical College, Abbottabad-22040, Pakistan.
Cell: +92-300-5635010
Email: drsaima79@yahoo.com6.
Walsh LE, Garg BP. Ischemic strokes in children. Indian J
Pediatr 1997;64(5):61323.
de V eber G. The Canadian Pediatric ischemic stroke study
group. Canadian pediatric ischemic stroke registry: analysis of
children with arterial ischemic stroke. Ann Neurol 2000;48:526.
Tham EH, Tay SK, Low PS. Factors predictive of outcome in
childhood stroke in an Asian population. Ann Acad Med
Singapore 2009;38(10):87681.
Ganesan V, Prengler M, Mc Shana MA, Wade AM, Kirkham FJ.
Investigation of risk factors in children with arterial ischemic
stroke. Ann Neurol 2003;53(2):16773.
Address for Correspondence:
Dr. Saima Bibi, Senior Lecturer, Department of Physiology, Ayub Medical College, Abbottabad-22040, Pakistan.
Cell: +92-300-5635010
Email: drsaima79@yahoo.com23.
de V eber G. The Canadian Pediatric ischemic stroke study
group. Canadian pediatric ischemic stroke registry: analysis of
children with arterial ischemic stroke. Ann Neurol 2000;48:526.
Tham EH, Tay SK, Low PS. Factors predictive of outcome in
childhood stroke in an Asian population. Ann Acad Med
Singapore 2009;38(10):87681.
Ganesan V, Prengler M, Mc Shana MA, Wade AM, Kirkham FJ.
Investigation of risk factors in children with arterial ischemic
stroke. Ann Neurol 2003;53(2):16773.
Address for Correspondence:
Dr. Saima Bibi, Senior Lecturer, Department of Physiology, Ayub Medical College, Abbottabad-22040, Pakistan.
Cell: +92-300-5635010
Email: drsaima79@yahoo.com81.
Ganesan V, Prengler M, Mc Shana MA, Wade AM, Kirkham FJ.
Investigation of risk factors in children with arterial ischemic
stroke. Ann Neurol 2003;53(2):16773.
Address for Correspondence:
Dr. Saima Bibi, Senior Lecturer, Department of Physiology, Ayub Medical College, Abbottabad-22040, Pakistan.
Cell: +92-300-5635010
Email: drsaima79@yahoo.com73.
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