Multifactorial Nature of Childhood Stroke Presents a Major Challenge for Diagnosis and Management: A Population-Based Study From Southern Finland.

Abstract

Aim: Childhood ischemic stroke is rare but causes substantial long-term morbidity, and its heterogeneous aetiology complicates timely diagnosis and management.

Methods: We conducted a retrospective population-based observational study using hospital data and chart review to describe diagnostics, treatment and outcomes of ischemic stroke in patients aged 1 month to 18 years treated at HUS Helsinki University Hospital between 2010 and 2023. Hemorrhagic strokes were excluded.

Results: Among 137 patients, the median annual incidence was 2.5 per 100 000 children. The five largest aetiological subgroups were idiopathic (18%), arteriopathy (16%), major surgery (13%), cardiac embolism (13%) and infection (12%). More than half of patients with available data were diagnosed more than 24 h after symptom onset. Hemiplegia was the most frequent symptom (44%), followed by seizures (25%), which were particularly common in infants. At follow-up, about half of the patients had motor and/or neuropsychological deficits. Epilepsy developed in 20 (15%) patients and recurrent stroke occurred in 8 (6%).

Conclusion: Childhood ischemic strokes in our population had heterogeneous causes and substantial long-term morbidity. Diagnostic delays were frequent, underscoring the need to improve recognition of paediatric stroke. The low recurrence rate highlights the importance of population-specific factors when interpreting risk and outcomes.