CHILDHOOD STROKES: EPIDEMIOLOGY, CLINICAL FEATURES AND RISK FACTORS

Saima Bibi, Syed Yasir H Gilani, Syed Raza Ali Shah, Sadia Bibi, Tahir S. Siddiqui

Abstract


Background: Stroke constitutes a significant health problem in paediatric population. The impact
of 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

Full Text:

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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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