Outcome in Childhood Stroke

Contrary to commonly held views, children do not recover better than adults after a stroke.1 The lifelong individual, family, and societal burden of stroke is likely to be greater than in adults because infants and children surviving stroke face many more years living with disability. The key difference between children and adults is that childhood stroke (occurring during the perinatal period and beyond) results primarily in a changed ability to achieve, rather than lose, functional independence. The extent and severity of deficits across motor, sensory, cognitive, social, and behavioral domains may not be apparent in the short-term after stroke, particularly in newborns and preschool children, who typically grow into their deficits.2,3 The World Health Organization’s International Classification of Functioning (ICF), Disability, and Health can be applied to childhood stroke to describe its impact across health domains, including impairment in body structures and functions, activity limitations and participation restrictions at individual, institutional and social levels. This review will focus on childhood stroke, defined as stroke from 1 month to 18 years of age, and where possible use the ICF framework to describe outcome after arterial ischemic stroke (AIS) and hemorrhagic stroke (HS). ### Mortality After Childhood Stroke Stroke is among the top 10 causes of death in the pediatric population. The reported mortality for AIS ranges from 7% to 28%1,4 and from 6% to 54% for HS.5 In the US study reporting stroke mortality during a 10-year period from 1979 to 1998, 4881 deaths could be attributed to childhood stroke, giving average annual mortality rates of 0.09 per 100 000 person-years for AIS 0.14 for intracerebral hemorrhage and 0.11 for subarachnoid hemorrhage.6 Risk of death was higher in infants, males, blacks, and children living in the South-Eastern Stroke belt States.6,7 Declining mortality rates have …