Evaluation of homocysteine level in children with cerebrovascular stroke

ABSTRACT

Cerebrovascular stroke is an important cause of morbidity and mortality in children. Recent epidemiologic data suggest that 3200 cases of stroke occur per year in the population aged between 30 days and 18 years in the US alone. Although outcome for stroke in children is significantly better than in adults, 20% die and 50%to 80% are left with significant disability. Moderately elevated homocysteine status is considered an independent risk factor for occlusive arterial disease in the peripheral arteries and cerebral vessels. Higher homocysteine levels could cause either isehemic stroke by it s procoagulative effects and induces endothelial damage or hemorrhagic stroke by promoting vascular inflammation and plaque rupture. To evaluate the role of homocysteine as a risk factor of cerebrovascular stroke in children. The study was conducted in intensive care and emergency units in Pediatric Assiut University Hospital during the period between October 2005 and September 2006 and included 52 children with stroke [65.4%ischemic and 34.6% hemorrhagic] and contained 34 boys and 18 girls, aged 30 days to 4.5 years after exclusion of stroke due to trauma and tumor as vell as 20 apparently healthy children with matchable age and sex as control group. All cases were evaluated by Pediatric National Institute of Health Stroke Scale on admission as a measure of stroke severity, besides meticulous history taking and thorough clinical examination. Evaluation of plasma levels of homocysteine, random blood glucose, serum sodium and potassium were done for all cases and controls. The annual frequency rate of stroke was 0.3%. The mean +/- SD of random blood glucose was significantly higher in children with ischemic compared to hemorrhagic stroke and in both compared to control. The mean +/- SD of serum sodium was significantly higher in ischemc compared to hemorrhagic and control groups. The mean +/- SD of serum potassium was significantly lower in ischemic and hemorrhagic stroke compared to control The mean +/- SD of homocysteine in children with ischemic and hemorrhagic strokes were more than control group with a statistical significant difference while, no statistical significant difference was detected between the two groups. The odds ratio of homocysteine for ischemic and hemorrhagic stroke were [3.3, CI 2.38-26.9] and [1.9, CI 2.3-46.8] respectively. The mean +/- SD of homocysteine was significantly higher in children with hospital stay more than 2 weeks, in children with PedNIHSS >/= 12 and in non survivors. Hyperhomocysteinemia is significant risk factor of stroke in children