Data from: Comparative study of posterior and anterior circulation stroke in childhood – results from the International Pediatric Stroke Study (IPSS)

Objective: This study compares risk factors, clinical presentation, and
outcomes after posterior circulation (PCAIS) and anterior circulation
arterial ischemic stroke (ACAIS) in neonates and children. Methods:
International multicenter observational study including neonates and
children up to 18 years of age with arterial ischemic stroke (AIS),
comparing clinical and radiological features according to stroke location.
Results: Of 2,768 AIS cases, 507 (18%) were located in the posterior
circulation, 1,931 (70%) in the anterior circulation, and 330 (12%)
involved both. PCAIS was less frequent in neonates compared to children
(8.8% versus 22%, p<0.001). Children with PCAIS were older than
children with anterior circulation arterial ischemic stroke (ACAIS),
(median age 7.8 (IQR 3.1-14) versus 5.1 (IQR 1.5-12) years,
p<0.001), and more often presented with headache (54% versus 32%,
p<0.001) and a lower PedNIHSS score (4 (IQR 2-8) versus 8 (IQR
3-13), p=0.001). Cervicocephalic artery dissections (CCAD) were more
frequent (20% versus 8.5%, p<0.001), while cardioembolic strokes
were less frequent (19% versus 32%, p<0.001) in PCAIS. Case
fatality rates were equal in both groups (2.9%). PCAIS survivors had a
better outcome (normal neurological examination at hospital discharge in
29% versus 21%, p=0.002) than ACAIS survivors, although this trend was
only observed in children and not in neonates. Conclusion: PCAIS is less
common than ACAIS in both neonates and children. Children with PCAIS are
older, have a higher rate of CCAD, lower clinical stroke severity, and
better outcome than children with ACAIS.