الفهرس 
arabic summary
Vascular supply of the brainOnly 14 pages are availabe for public view
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Abstract
The present study is conducted in Pediatric Assuit University Hospital during the period between October 2005and September 2006. Fifty-two children diagnosed as stroke by either CT or MRI were included in the study. They were selected from the Pediatric Intensive Care Unit and the emergency units of Pediatric Assuit University Hospital. They were classified according to their diagnosis into 2 groups, Group 1: included 34 (65.4%) children with the mean age was 2.72 years diagnosed as ischemic stroke of whom 19 males (56%) and 15 females (44%). Group 11: included 18 (34.6%) children with the mean age was 2.11years diagnosed as hemorrhagic stroke of whom 15 males (83%) and 3 females (17%). Twenty apparently healthy children with machable age and sex were included in the study as a control group with the mean age was 3.2±3 years and 14 males (70%) and 6 females (30%).
Patients and controls were subjected to thorough history taking and complete physical examination included Pediatric NIHSS score on admission.
Laboratory investigations in the form of : Complete blood count, random blood glucose , electrolytes (Sodium, Potassium and Calcium) , blood culture, urine and Stool analysis , cerebrospinal fluid analysis and culture , arterial blood gases , liver function tests, determination of lipid profile , some coagulation factors and plasma level of Homocysteine.
We found that: The annual frequency rate of cerebrovascular stroke in Assuit Pediatric University Hospital in the period of study 0.3% cases. There were statistically significant differences between children with ischemic stroke and control groups as regard family history of smoking, stroke and
DM or hypertension, all were more prevalent in children with ischemic stroke than control groups with increased odds ratio to develop both ischemic and hemorrhagic stroke.
The identifiable etiologies of stroke in the studied cases were: CNS infection in 9 cases (26%) and in only a case (5.5%) in children with ischemic and hemorrhagic stroke respectively, cardiac diseases were detected only in children with ischemic stroke as 6 cases (17.5%) and systemic infections were detected in 7 cases (20%) and 5 cases (28 %) in children with ischemic and hemorrhagic stroke respectively.
CNS infection, fever, cardiac manifestations and acute gastroenteritis and or bronchopneumonia were the presenting symptoms in ischemic stroke, while hypertension, headache and bleeding tendency were more prevalent in hemorrhagic stroke. Convulsion was the most frequent neurological presentation in both groups.
Significantly higher mean±SD of systolic blood pressure and diastolic blood pressure was detected in children with ischemic stroke compared to hemorrhagic and in both compared to control group. While the mean±SD of heart rate was significantly higher in children with hemorrhagic stroke compared to ischemic and control groups.
The mean± SD of hemoglobin level and MCV in hemorrhagic and ischemic strokes were lower compared to control group. Significantly higher mean± SD of platelet count and white blood cells were detected when comparing children with stroke (ischemic and hemorrhagic) and control groups.
Significantly higher mean±SD of random blood glucose level was detected in children with ischemic stroke when compared to children with hemorrhagic stroke and in both groups compared to control group. The
mean±SD of serum sodium in children with ischemic stroke was more than hemorrhagic stroke and control group with significant difference.The mean±SD of serum potassium in children with ischemic and hemorrhagic strokes were less than control group with a statistical significant difference.
The mean± SD of serum cholesterol and LDL in children with ischemic stroke was more than hemorrhagic stroke as well as control group with a statistical significant difference. The mean± SD of HDL in children with ischemic stroke was less than control group with a statistical significant difference and increased odds ratio.
The mean± SD of protein C, protein S and antithrombin 111 in children with ischemic stroke was less than children with hemorrhagic stroke and control groups with a statistical significant difference and increased odds ratio. The mean± SD of Factor V111 in children with ischemic stroke was more than control group with a statistical significant difference.
Evaluation of homocysteine levels revealed that 15.2 umol/L was considered as the 95th percentile as the cut off –point of normal values above which homocysteine was considered abnormally elevated. The mean±SD of homocysteine in children with ischemic and hemorrhagic strokes were more than control group with a statistical significant difference with increased odds ratio for both. The sensitivity and positive predictive values of higher homocysteine to predict ischemic stroke (52% and 82% respectively) are higher than those for hemorrhagic stroke (33% and 60% respectively).
The mean±SD of homocysteine was more in children with obesity and in children with CNS infection with a statistical significant difference.
The mean±SD of homocysteine was more in children with positive family history of stroke and in children with obesity a statistical significant difference in ischemic stroke.
The mean±SD of homocysteine was significantly higher in children with high cholesterol levels and low HDL levels while insignificantly higher levels of homocysteine were detected in children with high levels of LDL and TGL.
Significantly higher mean±SD of homocysteine was detected in children with low levels of Protein S, Protein C and Antithrombin.
Positive correlations were detected between homocysteine level and positive family history of smoking, body mass index, systolic and diastolic blood pressure, cholesterol, LDL and TGL. While negative correlations were detected in children with HDL, Protein C, Protein S and Antithrombin.
73.5% and 66.6% of ischemic and hemorrhagic strokes respectively stayed more than 2 weeks in the hospital, 33.3% of hemorrhagic stroke improved without sequlae compared to 20.6% in ischemic stroke. Epilepsy was the most prevalent sequlae in ischemic stroke.
In hemorrhagic stroke, 5 cases (27.8%) died compared to 4 cases (11.8%) in ischemic stroke with no significant difference.
The mean±SD of pediatric NIHSS was higher in cases with hospital stay more than 2 weeks, in children improved with sequelae and in non –survivors with a statistical siginificant differences. Significantly higher mean±SD of homocysteine was detected in children with pedNIHSS 12 scores, in those with longer hospital stay and in non-survivors.
Conclusion
Childhood stroke is not uncommon in our locality.
The stroke is multifactorial and interrelated. The presence of more than one risk factor increases the liability to develop stroke.
Family history of stroke and smoking, obesity and hypertension are definite risk factors of stroke in our children.
Abnormalities in the lipogram and abnormal levels of the studied coagulation factors are considered significant risk factors of stroke in our children.
Higher level of homocysteine is considered an independent risk factor of stroke (ischemic and hemorrhagic).
Correlations were detected between homocysteine , lipogram and the studied coagulation factors.
Initial homocysteine levels and pedNIHSS scores 12 can predict poor outcome of stroke.