A new study shows that the diagnosis of ischemic stroke, which results from a loss or obstruction of blood to the brain, is on the rise in New Jersey children. According to the National Stroke Association, stroke is one of the top 10 causes of death among children.
The research, published in Neurology®, the medical journal
of the American Academy
of Neurology, was conducted by researchers at the Cardiovascular Institute of
New Jersey (CVI) at the University
of Medicine and Dentistry
of New Jersey-Robert Wood Johnson Medical School.
"This is the first statewide study that examines the
incidence and long-term mortality from all types of stroke in New Jersey children from one month to 19
years of age," said Sampada Gandhi, MBBS, MPH, instructor of medicine and
primary author of the study. "The data report on an important trend for which
little evidence exists, but which is imperative for physicians to understand to
improve diagnosis and treatment in children with stroke."
The researchers used the Myocardial Infarction Data
Acquisition System (MIDAS) to examine the incidence of, and fatality from,
ischemic stroke and hemorrhagic stroke (resulting from internal bleeding in the
brain) in children from 1994 to 2007. MIDAS is a statewide database coordinated
by CVI that tracks hospitalizations for myocardial infarction (heart attack),
stroke, other vascular diseases, and deaths from 1986 to the present. The
research also included a review of mortality rates at 30-days, one year and
five years after initial stroke diagnosis.
The data show an initial decrease in the incidence of
ischemic stroke in children from 1994 to 2001, but an increase in pediatric
ischemic stroke thereafter. The study also shows that pediatric hemorrhagic
stroke is twice as likely to be fatal when compared to ischemic stroke, but the
incidence of hemorrhagic stroke remained stable throughout the 14-year study
"We believe that the initial decrease in ischemic stroke is
the result of better stroke prevention in children at risk, particularly in
children with sickle cell disease," said James S. McKinney, MD, assistant
professor of neurology at Robert Wood Johnson Medical School, and medical
director of the Comprehensive Stroke Center at Robert Wood Johnson University
Hospital, who contributed to the study. The subsequent increase in stroke in
latter years is at least partially explained by "better awareness of stroke
symptoms, improved diagnostic tools, including more accurate MRI testing, in
According to the study, the data for New Jersey children are consistent with
national trends and show that more than 17 percent of pediatric strokes were
fatal within the first five years. The most prevalent reasons for pediatric
ischemic stroke were the existence of hypertension, sickle cell disease and
meningitis/encephalitis. Children who suffered from hemorrhagic stroke were
more likely to have cardiac dysrhythmias and arteriovenous malformations (AVMs).
The study also showed that approximately 75 percent of the children suffering
from stroke died of non-cerebrovascular causes.
In addition to Dr. Gandhi and Dr. McKinney,
contributors from Robert Wood Johnson Medical School include Nora M. Cosgrove, RN,
head nurse; Jeanine E. Sedjro, MS, research teaching specialist; and John B.
Kostis, MD, the John G. Detwiler Chair of Cardiology, professor of medicine,
and founding director of The Cardiovascular Institute of New Jersey; and from
Rutgers University, Javier Cabrera, PhD, professor and director, department of
biostatistics. The study was supported by the Robert Wood Johnson Foundation
and the Schering-Plough Foundation.