Risk factors, clinical characteristics, and outcomes of recurrent pediatric stroke: A study from Bangladesh

Objective: Stroke is relatively rare in children, but it can lead to significant morbidity and mortality. Understanding the risk factors related to stroke will optimize the outcomes in children. Published cohorts of children with stroke recurrence rates are variable. This study has been done to determine the risk factors, clinical features, and outcomes of recurrent pediatric stroke in a developing country. Materials and Methods: We enrolled 98 children with stroke: 16 children were excluded due to incomplete investigations and were lost to follow-up. This study was conducted in a tertiary care hospital in Dhaka, Bangladesh from January 2017 to December 2019. Detailed investigations regarding stroke, physical examination, and targeted investigations were done. Results: We studied 82 patients: Among them, 52 had their 1st attack, and 30 had recurrent attacks of stroke. The age range of onset of stroke was 4.78 ± 3.90 and 5.30 ± 4.25 in the first and recurrent stroke, respectively. In this study, 36.5% of the enrolled children presented with a recurrence of stroke, whereas the rest presented with the first episode of stroke. The most common cause of recurrent stroke was intracranial vasculopathy, with the most common being vascular narrowing and moya moya disease (MMD). Protein C deficiency was observed more frequently in recurrent stroke. No significant difference was found in the risk factors of the first and recurrent stroke. During follow-up, patients with recurrent stroke developed cognitive decline, epilepsy, and speech disorder more frequently. Conclusion: In children with recurrent stroke vasculopathy, particularly MMD and protein C deficiency were observed more frequently. Moreover, in this group, sequelae-like cognitive dysfunction, speech disorder, and epilepsy were observed more frequently.