Lived experience of having a child with stroke: A qualitative study.

OBJECTIVE: To assess the lived experience of parents whose child has suffered a stroke. METHODS: A qualitative study model was chosen, comprising in-depth interviews with parents separately or altogether. A semi-structured interview guide was used. Interviews were audio-recorded, transcribed verbatim and analysed using constant comparison and content analysis. Participant checking was performed. Thirteen families of children aged 1 month to 17 years, having suffered ischaemic or haemorrhagic arterial stroke within one to five years, were recruited. Interviews were conducted within home setting. RESULTS: After fourteen interviews, data saturation was met and six main narrative themes were identified, underlining a common path of stroke lived experience: brutality of diagnosis, lack of information regarding disease condition, feeling of abandonment after discharge from hospital, focus on functional recovery, late awareness of cognitive disorders, and need for psychological support and family adaptation. CONCLUSION: This is the first qualitative study reporting lived experience of childhood stroke caregivers. In line with other qualitative studies exploring the feelings of parents coping with severe neurological conditions of childhood, our results advocate the need for evaluation of family centred health interventions.

Secondary Prevention of Childhood Arterial Ischemic Stroke.

This study aimed to know how frontline physicians in France, Belgium, and Switzerland implement guidelines regarding the secondary prevention of childhood arterial ischemic stroke and to introduce physicians' point of view on a clinical trial assessing the efficacy of aspirin as a preventive strategy. The authors conducted an online survey directed at specialists throughout dedicated networks and used a mixed method for data analysis. Overall, 63 physicians responded, and 88% prescribe aspirin when sickle cell disease, cardio-embolic stroke, and dissection of cervical arteries are excluded. Prescribing habits vary among respondents with respect to their specialty. A majority would choose placebo or a treatment given to historical controls to compare with an aspirin arm in a trial. In studied countries, there seems to be good adherence to guidelines regarding the secondary prevention of childhood stroke. A trial assessing the efficacy of aspirin could be well accepted if several factors regarding study design were taken into account.

Inaugural cerebral sinovenous thrombosis revealing homocystinuria in a 2-year-old boy.

Cerebral sinovenous thrombosis is unusual during childhood and requires early and accurate management because of its detrimental consequences. We report on the case of a 2-year-old boy with mild psychomotor delay, who presented with nonfebrile acute ataxia. A brain computed tomographic (CT) scan showed complete thrombosis of the superior sagittal sinus, confirmed by magnetic resonance angiography and associated with a right frontal hemorrhagic infarction. Systematic screening for thrombophilia revealed homocystinuria linked to cystathionine ß-synthase deficiency with underlying compound heterozygosity. The evolution was favorable after anticoagulant therapy, specific diet, and vitamin supplementation. This case is of interest because of the unusual clinical presentation as a pediatric cerebral sinovenous thrombosis. Furthermore, homocystinuria is rarely revealed by cerebral sinovenous thrombosis at the onset of the disease and should systematically be ruled out in pediatric stroke.

[Antithrombotic medications and childhood stroke]. / Place des antithrombotiques dans l'accident vasculaire cérébral de l'enfant.

Each year, 500 to 1000 children experience a stroke in France. Long-term follow-up demonstrates persistent neurologic deficit in most of them. Despite the lack of studies with high level of evidence, paediatric stroke guidelines are regularly updated based on observational data, analogy with recommendation for adults, and expert opinion. It is reasonable to initiate anticoagulation during the acute phase of cerebral sinovenous thrombosis in children; the duration of anticoagulation needs to be individually tailored. It is not yet possible to draw any conclusions regarding neonates. Intravenous or intra-arterial thrombolysis and mechanical devices have the potential to provide instant and safe recanalization under optimal circumstances, but no generalization about their efficacy in childhood ischemic stroke can be drawn. Aspirin is effective in reducing the risk of recurrence in children with arterial ischemic stroke. There is a need to develop new studies with easy for use of antithrombotic drugs, such as aspirin or oral direct factor Xa inhibitors. A specific approach for rare disease population, which follows guidance for the design and conduct of paediatric trials, is required.

Lack of progressive arteriopathy and stroke recurrence among children with cryptogenic stroke.

OBJECTIVE: We hypothesized that cryptogenic forms of arterial ischemic stroke (AIS) in children may present better outcomes than symptomatic ones. METHODS: We conducted a single-centered retrospective cohort study using chart reviews of all inpatients aged 0.25-16 years and admitted for AIS or TIA between 1994 and 2007. Sixty-three consecutive children with AIS were divided into 2 stroke categories: first, AIS with an established cause, considered as symptomatic (S), and second, AIS only associated with risk factors, and considered as cryptogenic (C). AIS were further subclassified according to the CASCADE stroke classification system. We measured long-term outcome with 2 endpoints: recurrence rate and neurologic impairment score (NIS). We used univariate analysis to compare the clinical and radiologic characteristics of both groups. RESULTS: AIS were cryptogenic in 28 patients (44%) and symptomatic in 35 (56%). Compared to patients in group S, patients in group C showed an absence of stroke recurrence under prolonged aspirin treatment (0% vs 30.3%; p < 0.01), a predominance of nonprogressive arteriopathies (p = 0.02), unilateral infarcts (p = 0.01), M1 segment stenosis (p = 0.02), and better stroke outcomes (mean NIS 2.7 vs 4.2; p = 0.04). Within group C, patients with post-varicella arteriopathy (PVA) had a profile comparable to that of patients with non-PVA strokes in terms of infarct topography, localization of vascular lesions, recurrence rate, and neurologic outcome. CONCLUSION: Cryptogenic AIS during childhood is a homogeneous clinical and radiologic entity, likely reflecting similar underlying pathophysiologic mechanisms. Under early and prolonged treatment with aspirin, cryptogenic AIS does not recur.

Angelman syndrome and pseudo-hypsarrhythmia: a diagnostic pitfall.

Angelman syndrome is a rare genetic disorder scarcely diagnosed before the age of two years. We report the case of an eight-month-old female presenting with severe hypotonia, myoclonus, suspected spasms and an electroencephalogram with hypsarrhythmic-like features. She was initially treated with vigabatrin which resulted in worsening of myoclonic jerks. Fluorometric in situ hybridization revealed a chromosomal deletion at region 15q11-13. We discuss the case and differential diagnosis with other conditions including West syndrome. [Published with video sequences].