Predictors Of Stroke Outcome In Chidren

March 31, 2020 updated by: Ahlam Abdelbast Mohamad, Assiut University

Predictors Of Stroke Outcome In Children Admitted To Assiut University Children Hospital

Stroke can be defined as an abrupt loss of brain function that is caused by decreased cerebral blood flow.

Stroke can occur at all stages of life, but presentation is variable depending on age, involved artery, and underlying risk factors.

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

Detailed Description

Introduction Stroke can be defined as an abrupt loss of brain function that is caused by decreased cerebral blood flow.

Stroke can occur at all stages of life, but presentation is variable depending on age, involved artery, and underlying risk factors.

Younger children usually present with non specific symptoms such as seizures and altered mental status, especially those younger than 1 year, whereas older children present with focal neurologic deficits such as hemiplegia.(Rosa M et al ., 2016) Types pediatric stroke can be divided into ischemic and hemorrhagic stroke. Ischemic stroke is defined as focal damage to an area of brain tissue within a vascular territory due to loss of blood flow or oxygenation. It differs from diffuse hypoxic-ischemic injury in its mechanisms and distribution. Ischemic stroke, which represents 55% of pediatric strokes, can be subdivided into injuries caused by arterial ischemic stroke (AIS), which is due to loss of arterial flow, or venous infarction, which is due to loss of flow in a draining cerebral vein or venous sinus. Cerebral sinovenous thrombosis (CSVT), which involves obstruction by clot of a major venous sinus draining the brain parenchyma, can lead to infarcted brain parenchyma; Hemorrhagic stroke includes spontaneous hemorrhage within the brain parenchyma (intraparenchymal hemorrhage) and spontaneous (nontraumatic) subarachnoid hemorrhage. (Miya E et al.,2016) Risk factors Risk factors for stroke in children differ from those in adults. Adult risk factors are centered mainly on obstructive atherosclerotic, arteriopathies, cardiovascular disease, and arrhythmias, which are seldom found as risk factors in children. Stroke in children occurs primarily through 2 mechanisms, ischemic and hemorrhagic.

The most common cause of ischemic stroke is thrombotic, which occurs more commonly in children, representing 30% to 60% of cases. Although less common in children, hemorrhagic stroke is mainly caused by arteriovenous malformation.1 Studies such as the International Pediatric Stroke Study (IPSS) have reported systemic risk factors for pediatric stroke including sickle cell disease, cardiac disorders, trauma, and major infections such as meningitis, sepsis, and encephalitis, but in most cases, no systemic disease was found.(Rose M et al ., 2015) &(Simma B et al., 2013) Outcome of stroke Outcome of arterial ischemic stroke (AIS) in children is considered more favorable than in adults due to the better brain plasticity in children. However, several studies showed that more than half of survivors of childhood AIS have long-term physical disabilities and cognitive impairment. (Studer M et al .,2014) Although stroke etiolog and risk factors were different, stroke severity and clinical outcomes were similar (Bigi S et al .,2011) younger age at stroke is associated with poorer intellectual outcome and a broader spectrum of dysfunctions across multiple neuropsychological domains.(Allman C et al.,2013) Further, children with combined cortical and subcortical lesions have overall poorer cognitive outcome,(Westmacott R et al,.2010) larger lesion size negatively influences cognitive and functional outcome, possibly due to disruption of more neural network connections, adversely affecting functional brain organization.(Long B et al., 2011).

Regarding lesion laterality, controversial reports exist concerning the effect of lesion laterality on neuropsychological outcome. In addition, persistent seizures and persistent NI such as hemiplegia/paresis or visual field deficits also negatively influence neuropsychological and functional outcome. . (Allman C et al.,2013) NeuroImaging Brain magnetic resonance imaging (MRI) as more sensitive than computed tomography (CT) in diagnosis and detection of pediatric stroke. Head CT without contrast is the study of choice for identifying acute hemorrhage but may be normal in the cases of ischemic stroke in the first 12 to 24 hours after the event .( Alberts MJ et al., 2011)& (Elbers J et al.,2015) Therefore, MRI is a more sensitive modality for stroke including AIS, vascular malformations, and central nervous system inflammatory changes. Non contrast CT used for the detection of brain ischemia is more sensitive after the initial 24 hours.

Study Type

Observational

Enrollment (Anticipated)

30

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

1 month to 18 years (Child, Adult)

Accepts Healthy Volunteers

N/A

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

infant and children diagnosed as stroke by CT brain and MRI brain

Description

Inclusion Criteria:

  • - Infant and Children around age of (1month to 18years old) of both sexes were diagnosed as stroke (hemorrhagic or ischemic) by CT or MRI.

Exclusion Criteria:

  • - Neonates (less than one month)
  • Stroke caused by trauma
  • Patient refusal to participate the research

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Computed tomography(CT) of the brain
Time Frame: Baseline to 6 months after discharge
To detect the stroke type ;(hemorrhagic or ischemic) , location and severity at admission (at start of the study) and after discharge (6 months after discharge) .
Baseline to 6 months after discharge
Brain magnetic resonance imaging (MRI)
Time Frame: 1Year
It is more sensitive than brain CT in diagnosis and detection of pediatric stroke including AIS , vascular malformations , and central nervous system inflammatory changes.
1Year
Glasgow coma scale(GCS).
Time Frame: 1 year
To assess the level of consciousness to evaluate the extent of brain damage;(15_12) mild brain damage,(12_8) moderate brain damage,(<8 )severe brain damage.
1 year

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Assiut University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Anticipated)

December 1, 2020

Primary Completion (Anticipated)

December 1, 2020

Study Completion (Anticipated)

December 1, 2021

Study Registration Dates

First Submitted

September 24, 2019

First Submitted That Met QC Criteria

March 31, 2020

First Posted (Actual)

April 2, 2020

Study Record Updates

Last Update Posted (Actual)

April 2, 2020

Last Update Submitted That Met QC Criteria

March 31, 2020

Last Verified

September 1, 2019

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • posoicauch

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Ischemic Stroke

Clinical Trials on Brain magnetic resonance imaging (MRI) , computed tomography (CT)

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Uganda

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

3
Subscribe