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BP abnormalities prevalent in children with arterial ischemic stroke

Abnormal BP, blood glucose levels and temperature are prevalent among children with arterial ischemic stroke, according to data published in JAMA Neurology.

The researchers also concluded that infarct volume and hyperglycemia were associated with poor neurological outcome, but hypertension and fever were not.

“To our knowledge, no evidence-based guidelines are available for the management of [BP], blood glucose levels, or temperature after pediatric patients experience acute arterial ischemic stroke,” Kimberly N. Grelli, MD, of the University of Washington, in Seattle, and colleagues wrote. “Elevated BP can be harmful because it increases the risk of cerebral edema and hemorrhagic transformation and is associated with poor short-term and long-term outcomes in adults with ischemic stroke.”

To determine the prevalence of abnormal BP, blood glucose levels and temperature among children with acute arterial ischemic stroke, and if there is an association between these measures and neurological outcomes, the researchers conducted a retrospective review of 98 children aged 29 days to 18 years. The patients had experienced their first arterial ischemic stroke between January 2009 and December 2013, at a tertiary academic children’s hospital.

BP, blood glucose levels and temperature data were measured for 5 days following the stroke. Morbidity and mortality at 3 months were documented. The primary outcome measure was poor clinical outcome.

According to the researchers, hypertension was present in 65.3% of the patients, with hypotension present in 68.4%, hyperglycemia in 18.1% and fever in 37.8%. The strongest association with poor neurological outcome was an infarct size of 4% or greater of brain volume (OR = 5.6; 95% CI, 2-15.4; P = .001). Hyperglycemia was also associated with poor neurological outcome (OR = 3.9; 95% CI, 1.2-12.4; P = .02). Hypertension were not significantly associated with infarct size, poor outcome or death.

“In the present study, hyperglycemia and infarct size were both independently associated with increased disability after pediatric [arterial ischemic stroke],” Grelli and colleagues wrote. “While hypotension was also weakly associated with poor outcome, no significant association was observed between hypertension and poor outcome or death as seen in the adult literature and one prior pediatric study.” – by Jason Laday

Disclosure: The authors report no relevant financial disclosures.