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P13.3 Assessment and management of 68 cases of childhood stroke from a multicentric study from Spain
S84 Methods: A questionnaire was sent to every French neuropediatric academic center to estimate the prevalence, incidence (diagnosis <1 year), familial cases and location of MMD/MMS cases. Results: A 100% response rate was obtained, 53 pediatric cases were reported. Among them, nine children were diagnosed in the year preceding the survey. The prevalence of MMD/MMS was estimated at 0.39/100,000 children (95% CI: 0.28 0.49), the incidence at 0.065/100,000 children/year (95% CI: 0.025 0.12) with 7.5% of familial cases. The prevalence was homogenous within the different administrative areas. Conclusions: This first occidental nationwide survey of MMD/ MMS in children suggests that the prevalence of the disease in France is 1/10th of that estimated in Asia. These data support additional studies to obtain such information in adults and a detailed clinical picture of all cases. P13.3 Assessment and management of 68 cases of childhood stroke from a multicentric study from Spain E. Cardo Jalon1 *. 1 Hospital Son Llazter/UIB − Palma de Mallorca, ` Spain The aim of this retrospective study was to describe the clinical, neuroradiological, biochemical and therapeutic characteristic of children with stroke from the Gregorio Maranon ˜ hospital, (which is a major national centre specialised for the treatment and prevention of stroke in children) and others area of the center of Spain. Methods: Nine hospitals in Madrid and Albacete participated in this retrospective study between 2006 2008. We collected information and reviewed the medical records in order to provide demographic, clinical characteristics, risk factors, and outcome of children with stroke. Results: We identified a total of 68 children, 25 (36.8%) of them were neonatal, 31 (45.6%) were in the childhood period, and 12 (17.6%) were presumed perinatal stroke (PPIS). In the Neonatal period: there were 20 arterial ischemic stroke, 4 sinus venous thrombosis (SVT) and 1 stroke with arterial and venous involvement. The most frequent clinical presentation was focal seizures. The most common risk factors were perinatal asphyxia and heart disease. In the pediatric group: there were 27 arterial ischemic stroke and 4 SVT. The clinical presentation were seizures or hemiparesis. Important risk factors in this group were heart disease and vascular disease. MRI was the most sensitive diagnostic tool. Anterior vascular circulation and left hemisphere was the most affected territory. Eighteen patients (65.4%) received antithrombotic therapy: Eleven antiplatelet therapy (61%) and six anticoagulant therapy (33%). Almost two third (63%) of the patient develop long-term disabilities. Conclusion: Heart diseases were the leading cause of ischemic stroke and MRI the most reliable diagnostic tool. Obtained data will contribute to better understanding of pediatric stroke in Sapin and will provide a base for the establishment of the national referral center and national pediatric stroke registry. P13.4 The −455G>A polymorphism within fibrinogen beta gene in relation to plasma fibrinogen level and childhood stroke I. Kopyta1 *, B. Sarecka-Hujar2 , I. Zak3 , A. Balcerzyk3 , P. Niemiec3 , E. Emich-Widera1 . 1 Department of Neuropediatrics, Medical University of Silesia, Poland, 2 Department of Applied Pharmacy, Medical University of Silesia, Poland, 3 Department of Biochemistry and Medical Genetics, Medical University of Silesia, Poland Background: Pediatric ischemic stroke is a rare, heterogenous disorder. Elevated level of fibrinogen is one of the
Poster sessions prothrombotic factors influencing the risk of acute cerebroand cardiovascular episodes, both in adults and children. Earlier, it was shown that fibrinogen level was independently associated with an increased risk of overall ischemic stroke. The −455G>A polymorphism in fibrinogen beta gene (FGB) is related to individual differences in fibrinogen level so it may be considered as a risk factor for ischemic stroke. Aim of the study: The aim of the present study was to assess the relations between −455G>A polymorphism of FGB, fibrinogen level and ischemic stroke in the group of Polish children. Methods: We studied 49 children, including: 26 children after ischemic stroke (mean age:7.9±5.7) and 23 healthy children (mean age:12.4±4.1). Genetic analysis was performed using PCR-RFLP method. Fibrinogen levels were measured using coagulometer method and commercial kit. Results: We found that allele A of −455G>A polymorphism was more frequent in controls than in cases (37% vs 27%,p = 0.286). Carriers of A allele (GA+AA genotypes) were again more often in healthy children compared to stroke patients (70% vs 50%,p = 0.164). Levels of plasma fibrinogen were higher in cases (3.06±1.43) than in controls (2.46±0.73) although the difference was on bound of significance (p = 0.151). We observed that subjects with GA or AA genotype had slightly higher level of plasma fibrinogen than subjects with GG genotype (2.93±1.39 vs 2.51±0.65,p = 0.494). Conclusions: Levels of fibrinogen may be considered as risk factor for pediatric stroke in contrast to carrier-state of A allele of −455G>A polymorphism within FGB gene. P13.5 The Northern Greek stroke database D. Samakovitis1 , E. Vargiami2 , M. Economou2 , V. Soubasi3 , N. Gombakis2 , N. Printza2 , A. Anastasiou1 , E. Kontopoulos2 , D. Koliouskas4 , M. Athansiou-Metaxa1 , D. Zafeiriou2 *. 1 Depatrment of Radiology, “Hippokratio” General Hospital, Thessaloniki, Greece, 2 1st Department of Pediatrics, Aristotle University, Thessaloniki, Greece, 3 Department of Neonatology, Aristotle University, Thessaloniki, Greece, 4 Depatrment of Pediatric Oncology, “Hippokratio” General Hospital, Thessaloniki, Greece Introduction: Stroke and cerebrovascular disorders in childhood are a cause for significant morbidity. We report the results of the partly retrospective, partly prospective Northern Greek Stroke Database of children with arterial ischaemic stroke (AIS), neonatal stroke (NS), or symptomatic sinus venous thrombosis (SVT), who were admitted to the Department of Pediatrics between 2005 and 2010. Patients-Methods: 69 children aged 0−14 years (57.9% males; 42.1% females), 8.7% with NS and 11.6% with transient ischemic attacks. Data on risk factors (RF), presentation, diagnostic work-up, localisation, and both short- and longterm neurological outcome were collected. Results: Regarding their clinical presentation 62% of the patients presented with hemiplegia (26 right; 17 left), 17.3% with epileptic seizures, 6% with headache and vomiting and 14.5% with diverse symptomatology. Neuroimaging disclosed SVT in 18% of the cases and AIS in 82%. An underlying disease could be identified in 52.4% of the patients, with most frequent associations being congenital heart disease (13%), vascular disease [11.5%; 5 out of 7 children with with moya moya], iron deficiency (8%), CNS infection (3.3%) and malignancy (3.3%). The presence of thrombophilic factors could be demonstrated in 59% cases, while 14.7% had more than one factor. In 34.5% of the children, no underlying risk factors could be demonstrated. Follow-up ranged from 6 to 5 years. 6.5% of the children relapsed, one died, while impairments persisted in 49% (motor deficits in 42.6%, visual in 4.9%, speech in 13%, intellectual impairment in 11.4% and epilepsy in 23%).
Poster sessions prothrombotic factors influencing the risk of acute cerebroand cardiovascular episodes, both in adults and children. Earlier, it was shown that fibrinogen level was independently associated with an increased risk of overall ischemic stroke. The −455G>A polymorphism in fibrinogen beta gene (FGB) is related to individual differences in fibrinogen level so it may be considered as a risk factor for ischemic stroke. Aim of the study: The aim of the present study was to assess the relations between −455G>A polymorphism of FGB, fibrinogen level and ischemic stroke in the group of Polish children. Methods: We studied 49 children, including: 26 children after ischemic stroke (mean age:7.9±5.7) and 23 healthy children (mean age:12.4±4.1). Genetic analysis was performed using PCR-RFLP method. Fibrinogen levels were measured using coagulometer method and commercial kit. Results: We found that allele A of −455G>A polymorphism was more frequent in controls than in cases (37% vs 27%,p = 0.286). Carriers of A allele (GA+AA genotypes) were again more often in healthy children compared to stroke patients (70% vs 50%,p = 0.164). Levels of plasma fibrinogen were higher in cases (3.06±1.43) than in controls (2.46±0.73) although the difference was on bound of significance (p = 0.151). We observed that subjects with GA or AA genotype had slightly higher level of plasma fibrinogen than subjects with GG genotype (2.93±1.39 vs 2.51±0.65,p = 0.494). Conclusions: Levels of fibrinogen may be considered as risk factor for pediatric stroke in contrast to carrier-state of A allele of −455G>A polymorphism within FGB gene. P13.5 The Northern Greek stroke database D. Samakovitis1 , E. Vargiami2 , M. Economou2 , V. Soubasi3 , N. Gombakis2 , N. Printza2 , A. Anastasiou1 , E. Kontopoulos2 , D. Koliouskas4 , M. Athansiou-Metaxa1 , D. Zafeiriou2 *. 1 Depatrment of Radiology, “Hippokratio” General Hospital, Thessaloniki, Greece, 2 1st Department of Pediatrics, Aristotle University, Thessaloniki, Greece, 3 Department of Neonatology, Aristotle University, Thessaloniki, Greece, 4 Depatrment of Pediatric Oncology, “Hippokratio” General Hospital, Thessaloniki, Greece Introduction: Stroke and cerebrovascular disorders in childhood are a cause for significant morbidity. We report the results of the partly retrospective, partly prospective Northern Greek Stroke Database of children with arterial ischaemic stroke (AIS), neonatal stroke (NS), or symptomatic sinus venous thrombosis (SVT), who were admitted to the Department of Pediatrics between 2005 and 2010. Patients-Methods: 69 children aged 0−14 years (57.9% males; 42.1% females), 8.7% with NS and 11.6% with transient ischemic attacks. Data on risk factors (RF), presentation, diagnostic work-up, localisation, and both short- and longterm neurological outcome were collected. Results: Regarding their clinical presentation 62% of the patients presented with hemiplegia (26 right; 17 left), 17.3% with epileptic seizures, 6% with headache and vomiting and 14.5% with diverse symptomatology. Neuroimaging disclosed SVT in 18% of the cases and AIS in 82%. An underlying disease could be identified in 52.4% of the patients, with most frequent associations being congenital heart disease (13%), vascular disease [11.5%; 5 out of 7 children with with moya moya], iron deficiency (8%), CNS infection (3.3%) and malignancy (3.3%). The presence of thrombophilic factors could be demonstrated in 59% cases, while 14.7% had more than one factor. In 34.5% of the children, no underlying risk factors could be demonstrated. Follow-up ranged from 6 to 5 years. 6.5% of the children relapsed, one died, while impairments persisted in 49% (motor deficits in 42.6%, visual in 4.9%, speech in 13%, intellectual impairment in 11.4% and epilepsy in 23%).