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Stroke is associated with high mortality and long-term comorbidities in adults and children
.
Acute and short-term mortality have been extensively investigated, while long-term mortality has received less attention
stroke children
Because of the plasticity of the brain, the long-term prognosis after stroke in childhood is thought to be more favorable than stroke in adulthood, although there are no large-scale long-term studies to support this claim
.
Mortality studies after pediatric ischemic stroke often rely on small samples and subgroups; these studies did not use reference individuals (and therefore failed to report relative risks);
These studies yielded mixed results for acute (2.
6%-15%) and long-term mortality (12%-31%)
.
Long-term mortality after stroke has different risk factors in pediatric and adult stroke
Chronic comorbidities in children are rare after a perinatal stroke, and prognosis is often related to the actual stroke and its immediate management, rehabilitation, and future complications from brain injury
.
Ischemic stroke after the neonatal period shares some risk factors with ischemic stroke in adulthood, but the most common in children are arterial disease and infection
Infect
Finally, mortality studies in relatives of patients with pediatric ischemic stroke are currently unknown, although many risk factors for pediatric stroke and subsequent mortality have a genetic component
.
In this way, Heléne EK Sundelin et al.
of Caroline University, Sweden, identified 1606 ischemic stroke patients younger than 18 years old and their first-degree relatives (n=5714) through a nationwide registry in Sweden
.
Each ischemic stroke patient was compared with 10 age, sex, and county-matched reference subjects (control group)
.
Our primary analysis looked at 1327 children with ischemic stroke who were still alive one week after the event
They found that the mortality rate in the first 6 months was 40.
1 per 1000 person-years (95% CI, 24.
7-55.
6) compared with 1.
1 per 1000 (95% CI, 0.
3-1.
9) in the control group
.
The overall risk of death was hazard ratio (HR) = 10.
8 (95% CI, 8.
1-14.
3) and remained elevated after 20 years (HR = 3.
9 [95% CI, 2.
1-7.
1])
.
Children with ischemic stroke died from neurological disease (HR=29.
Blood vessel
Compared with relatives in the control group, first-degree relatives of children with ischemic stroke had an increased risk of death (HR=1.
21 [95% CI, 1.
05-1.
39]), siblings (HR=1.
52 [95% CI, 1.
09- 2.
11]) and relatives of patients with ischemic stroke >28 days (HR=1.
23 [95% CI, 1.
06-1.
42]) at highest risk
.
The significance of the study lies in its findings: Long-term mortality increases after pediatric ischemic stroke , and even after 20 years, neurological disorders are the most common cause of death
.
Original source:
[Sundelin HEK, Walås A, Söderling J, Bang P, Ludvigsson JF.
Long-Term Mortality in Children With Ischemic Stroke: A Nationwide Register-Based Cohort Study.
Stroke.
Long-Term Mortality in Children With Ischemic Stroke: A Nationwide Register-Based Cohort Study.
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