[Ischemic stroke in children--a diagnostic challenge].

BACKGROUND, MATERIAL AND METHODS: Ischaemic cerebral infarctions are relatively uncommon in childhood, and the aetiologies seen in this age group are different from those commonly seen in adults. This study presents clinical findings, investigation results and outcome in a five-year material collected between 1994 and 1999 in our department. It includes 22 children with ischaemic strokes aged three months to 13 year at the first or only stroke episode. RESULTS: The symptoms caused by ischaemic strokes in this age group vary and are often combined. Motor symptoms dominate, and we found hemiplegia, facial palsy, visual disturbances and reduced consciousness, listed according to decreasing occurrence. Infections and cardiac diseases or procedures were the most common aetiologies, both occurring with 22%. Other groups were autoimmune diseases (14%), malignancies (5%) and dissection of the a. carotis after trauma (5%). None of the patients in this material died as a result of the ischaemic stroke; 27% recovered completely. 41% had light sequela, 18% moderate sequela, and 14% ended up severely disabled. 18% had recurrent stroke episodes. INTERPRETATION: Appropriate examination after stroke in childhood is of great importance, since some of the aetiologies are associated with recurrence risk. Based on our clinical experiences and literature studies, we suggest a plan for diagnostic evaluation and treatment strategies for children who undergo an acute cerebral vascular disease.