Etiologies, management, and outcomes of pediatric stroke at a tertiary care center in Thailand

Abstract

Background: Recent developments in neuroimaging and treatments, such as thrombolysis and endovascular thrombectomy, have improved pediatric stroke diagnosis and management. However, limited contemporary data exist on stroke characteristics related to the clinical outcomes among Thai children.

Objectives: This study aimed to examine the clinical characteristics, investigations, treatments, and outcomes in pediatric Thai patients with stroke.

Methods: Children aged 28 days to 18 years with “cerebrovascular disease” recorded as the ICD-10 code and inpatient records from January 2011 to September 2022 were enrolled. The outcomes included disability at discharge (modified Rankin scale (mRS) grade 4–5), in-hospital mortality, and 2-year recurrent stroke rate.

Results: Of the 206 included patients, 53.4% had ischemic stroke, 36.4% had hemorrhagic stroke, and 10.2% had cerebral venous sinus thrombosis. The main presentations were weakness (49.5%), headache (35.4%), and altered consciousness (26.2%). The most prevalent etiologies for each stroke type were moyamoya vasculopathy in acute ischemic stroke, arteriovenous malformation in hemorrhagic stroke, and medicationrelated conditions such as L-asparaginase and oral contraceptive use in cerebral sinus venous thrombosis. Hemorrhagic stroke had the highest mean mRS (2.8 ± 2.2, P < 0.001) and in-hospital mortality (21.3%, P < 0.001). Only one case underwent endovascular thrombectomy.

Conclusion: Pediatric stroke in Thai children presents with diverse etiologies and clinical manifestations, with hemorrhagic stroke exhibiting the highest disability and mortality rates. These findings emphasize the need for targeted research into early diagnostic protocols, risk stratification tools, and the feasibility of advanced interventions such as endovascular thrombectomy in pediatric populations.