Abstracts

RATIONALE: Although strokes in both children and adult usually present with hemiparesis in most cases, there are remarkable differences in presentation of cerebrovascular accidents between these two groups. Seizures are reported to herald the onset of stroke in infants and children, which are exceedingly rare in adult cases. METHODS: We retrospectively reviewed the medical records of all pediatric patients with the discharge diagnosis of cerebrovascular accidents (CVA) in our institution from January 1995-March 2000. Patients with the diagnosis of seizures concurrent with CVA were included in the study. The etiology of CVA, results of neuroimaging studies,onset and classification of seizures were reviewed. Patients with the diagnosis of cerebral infarct and hemorrhage from closed head injuries secondary to motor vehicular accidents, shaken baby syndrome and other forms of head trauma were excluded. RESULTS: There were 68 patients with the discharge diagnosis of cerebrovascular accident (CVA) during this period. Age ranged from neonate to 18 years old. Fifty-four patients were included in the analysis and fourteen were excluded. Thirty-two patients had seizures reported with CVA (59%). Twenty-seven patients (84%) had their seizures at the onset or acute phase of CVA (<7 days of CVA), and the timing of seizures in five patients were undertermined. Focal seizures occured in 19 patients (59%), focal with secondary generaliztion in 3 patients, and generalized seizures in 10 patients. Twenty-five patients had ischemic strokes and 7 had hemorrhagic strokes. Cortical involvement was reported in 30 patients and only 2 had subcortical strokes. The etiologies of stroke include neonatal asphyxia (6), cardiac (4), infection (3), vasculopathy (3), vasculitis (1), Brain tumor (1), and undertermined (14). CONCLUSIONS: Seizures are common presenting manifestations of stroke in children. Focal seizures are the commonest type, followed by generalized, and focal with secondary generalization. There appears to be highly correlation between seizures and ischemic stroke with cortical involvement.