Clinical Characteristics of Childhood Cerebrovascular Disease and Analysis on the Prognostic Factors

Hwang, Yong Seung; Yang, Moon Sun

Abstract

PURPOSE: Cerebrovascular disease in children is more common than was once recognized and the etiology and prognosis of the disease in children are quite different from those of adults. Recently according to medical reports and clinical experiences, the incidence of childhood cerebrovascular disease is increasing in Korea. To clarify the clinical features of childhood cerebrovascular disease and to analyze its prognostic factors, retrospective study was perinatal problem, trauma or hypoxia.
METHODS
We reviewed clinical records of the patients who had admitted to Seoul National University Children's Hospital during 5 years from Jan. 1989 to Dec. 1993.
RESULTS
There were 82 cases(66.8%) of ischemic cerebrovascular disease as well as 41cases(33.3%) of hemorrhagic cerebrovascular disease. Various predisposing causes were known in 108 cases(87.8%); vasculopathy was frequent in ischemic group while hemato-oncologic disease was frequent in hemorrhagic group. The presenting symptoms and signs of childhood cerebrovascular disease were seizure, motor paralysis, headache, altered consciousness, etc. Transient ischemic attack and bulbar palsy were relatively common in ischemic group while ltered consciousness was more frequent in hemorrhagic group. The overall mortality of childhood cerebrovascular disease in this study was 11.4%, and deaths were frequent in hemorrhagic group(24.4%) than in ischemic group(4.9%) (p<0.005). Patients with a hemato-oncologic disease as a predisposing cause, and with an alteration of consciousness as a presenting sign were at increased risk for death (p<0.0005). Only 37 cases(33.9%) of the 109 patients surviving stroke were recovered completely while 72 cases(66.1%) had one or more residual deficits. Residual deficits occurred more often following ischemic stroke(71.8%), than after hemorrhagic stroke (51.6%), and complete recovery vice versa. Motor deficit was the commonest of the residual deficits. But the majority of motor deficits were mild and disability in fine motor control is common. Unlike in adults, seizure, mental retardation and learning disability were common as residual deficits in children.
CONCLUSIONS
Considering above results childhood cerebrovascular disease is not so rare in Korea. And the clinical features and prognosis of cerebrovascular disease in children were somewhat different from those in adults. Since the outcome of childhood cerebrovascular disease is not so good, further exact and inclusive studies on this subject are required for early diagnosis and treatment which are important in decreasing mortality and morbidity of the disease.