Paediatric stroke in Estonia: epidemiology and risk factors
Date
2010-05-19T05:24:58Z
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Abstract
Lastel esineb insulti sagedamini, kui üldiselt arvatakse. Laste insuldi uuringute arv on viimastel aastakümnetel tunduvalt kasvanud. Peamised edusammud lapseea insuldi diagnoosimisel on seotud neuroradioloogiliste uurimisvõimaluste olulise paranemisega ja arstkonna suurenenud teadlikkusega lapseea insuldist. Laste insuldi tekkemehhanism jääb tihti ebaselgeks, sest arvestada tuleb paljusid erinevaid riskitegureid.
Eestis ja ka mujal Ida-Euroopas puudusid kuni praeguse uurimuseni laste ajuinsuldi epidemioloogiat käsitlevad uuringud. Töö eesmärgiks oli uurida perinataalse ja lapseea insuldi haigestumust, kliinilisi sümptomeid ja riskitegureid. Lisaks veel perinataalse insuldi neuroloogilist hilistulemust, lapseea arteriaalse isheemilise insuldi diagnoosimise kiirust ja kahe enimuuritud tromboosi soodustavate geenimutatsioonide (V hüübismisteguri Leideni mutatsioon ja protrombiini 20210G>A mutatsioon) seost laste isheemilisse insulti haigestumisega.
Uurimuse tulemusena selgus, et perinataalse insuldi haigestumus Eestis on 63 juhtu 100 000 ehk 1 juht 1578 elussünni kohta – seda on rohkem kui varem teistes maades kirjeldatud. Lapseea insuldi esmashaigestumus Eestis on 2,73 juhtu 100 000 lapse kohta aastas, mis on sarnane teiste uuringute tulemustega. Ühel kolmandikul perinataalse insuldiga lastest esinevad neuroloogilised sümptomid (krambid, teadvushäire) vastsündinuperioodis (neonataalne insult). Ülejäänud kaks kolmandikku lastest jõuab eriarsti vastuvõtule keskmiselt 8 kuu vanuses peamiselt hemipareesi tõttu (tõenäoline perinataalne insult). Perinataalse insuldi riskiteguriteks olid sagedamini esmassünnitus, erakorraline keisrilõige, Apgari hinne 1. minutil alla 7, preeklampsia ja protrombootilised tegurid. Arteriopaatia, südamepatoloogia ja protrombootilised tegurid esinesid sagedamini lapseea ajuinfarkti korral. Kõigil perinataalse insuldiga lastel esines neuroloogilise jääkleiuna hemiparees. Epilepsia esines ühel kolmandikul nii neonataalse kui ka tõenäoliselt perinataalse insuldiga lastest. Lapseea ajuinfarkti diagnoos hilines keskmiselt 9,2 päeva. V hüübismisteguri Leideni ja protrombiini 20210G>A mutatsioonid suurendavad lastel sinovenoosse tromboosi riski 3 korda.
Stroke is an increasingly recognised cause of childhood mortality and long-term neurological morbidity. The number of studies on paediatric stroke has increased over the past decades due to increased recognition and the possibilities of modern neuroradiology. Many disorders and risk factors have been associated with paediatric stroke but the pathogenesis of stroke in children remains is often unclear. Paediatric stroke in Estonia is not investigated earlier and the incidence of stroke among children in this country is unknown. The present study was designed to investigate the incidence rate of paediatric stroke in Estonia and to evaluate the risk factors of paediatric stroke. Additionally, we studied the outcome of perinatal stroke, time lag to the diagnosis of childhood arterial ischemic stroke and the association between Factor V Leiden and prothrombin 20210G>A and paediatric ischemic stroke. Our study revealed that the incidence rate of perinatal stroke in Estonia is 63/100,000 incidence rate of perinatal stroke in Estonia is 63 per 100,000 live births, which is more than estimated in previous studies in other countries. The incidence rate of childhood stroke in Estonia is 2.73/100,000, which is similar to earlier reported data. One-third of patients with perinatal stroke have symptoms (most often seizures) after birth (neonatal stroke). The remaining two-thirds reach medical attention at a mean age of eight months, mostly because of hemiparesis (presumed perinatal stroke). Most frequently identified risk factors of perinatal stroke are primiparity, emergent caesarean section, an Apgar score <7 at the first minute, preeclampsia and prothrombotic factors. Arteriopathy, cardiac disorder and prothrombotic factors are the main risk factors of childhood AIS. Hemiparesis occurs in all children with perinatal stroke at outcome. Epilepsy develops in one-third of children, both with neonatal and presumed perinatal stroke. The diagnosis of childhood AIS is delayed at average 9.2 days. Children carrying factor V Leiden or prothrombin 20210G>A mutation have 3.1-fold increased risk to have sinovenous thrombosis.
Stroke is an increasingly recognised cause of childhood mortality and long-term neurological morbidity. The number of studies on paediatric stroke has increased over the past decades due to increased recognition and the possibilities of modern neuroradiology. Many disorders and risk factors have been associated with paediatric stroke but the pathogenesis of stroke in children remains is often unclear. Paediatric stroke in Estonia is not investigated earlier and the incidence of stroke among children in this country is unknown. The present study was designed to investigate the incidence rate of paediatric stroke in Estonia and to evaluate the risk factors of paediatric stroke. Additionally, we studied the outcome of perinatal stroke, time lag to the diagnosis of childhood arterial ischemic stroke and the association between Factor V Leiden and prothrombin 20210G>A and paediatric ischemic stroke. Our study revealed that the incidence rate of perinatal stroke in Estonia is 63/100,000 incidence rate of perinatal stroke in Estonia is 63 per 100,000 live births, which is more than estimated in previous studies in other countries. The incidence rate of childhood stroke in Estonia is 2.73/100,000, which is similar to earlier reported data. One-third of patients with perinatal stroke have symptoms (most often seizures) after birth (neonatal stroke). The remaining two-thirds reach medical attention at a mean age of eight months, mostly because of hemiparesis (presumed perinatal stroke). Most frequently identified risk factors of perinatal stroke are primiparity, emergent caesarean section, an Apgar score <7 at the first minute, preeclampsia and prothrombotic factors. Arteriopathy, cardiac disorder and prothrombotic factors are the main risk factors of childhood AIS. Hemiparesis occurs in all children with perinatal stroke at outcome. Epilepsy develops in one-third of children, both with neonatal and presumed perinatal stroke. The diagnosis of childhood AIS is delayed at average 9.2 days. Children carrying factor V Leiden or prothrombin 20210G>A mutation have 3.1-fold increased risk to have sinovenous thrombosis.
Description
Väitekirja elektroonilisest versioonist puuduvad publikatsioonid.
Keywords
insult, lapsed