POSTERIOR CIRCULATION ARTERIAL ISCHEMIC STROKE IN CHILDREN

Objective —We describe the clinical and radiological features of PCAIS in children from a developing country.

Methods—Data of children with radiologically confirmed PCAIS during the period of September 2020 to March 2022 were retrieved. The demographic profile, clinical presentation, radiological findings, risk factors and treatment given were noted. Infarcts were divided into proximal, middle, and distal posterior circulation segments utilizing an adult topographical classification system. The condition on discharge was graded according to the modified Rankin scale.The CASCADE classification system(CCS) was used to define stroke subtypes.

Results— 12 children were found to have radiologically confirmed isolated PCAIS with a median age of 54 months (IQR = 93.5) of which 10 (83%) were boys. Clinical features were headache/vomiting(4), seizures(3), altered sensorium(5), weakness(3), gait instability(4) and cranial nerve palsies(4). Time to referral to tertiary centre was > 24 hours in 7/12. Infarct location was distal (5), middle (3), proximal (2), and multiple segments (2). MRA was abnormal in 6/9 children. The CCS was applied to 10 children of which 2, 2 and 6 were classified in categories 2c, 5 and 6b respectively. Based on the secondary classification our cohort had hematological(4), infectious(3) and inflammatory(3) risk factors . For treatment 11 received aspirin, one received LMWH and one underwent mechanical thrombectomy. 9 children survived the stroke. On follow up 3/7 had no symptoms while 4 had mild symptoms but no disability.

Conclusions : Etiology and outcome of PCAIS is different in our cohort from the developed countries.
Keywords: PCAIS POSTERIOR CIRCULATION INFARCT