Clinical Profile and Etiology of Pediatric Patients With Stroke at St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia

Clinical Profile and Etiology of Pediatric Patients With Stroke at St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Profile and Etiology of Pediatric Patients With Stroke at St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia Mahlet Getnet, Endayen Deginet, Ayalew Moges This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7723699/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background/Objectives : Pediatric stroke, though rare, remains a significant cause of morbidity and mortality in children. The condition presents a diagnostic challenge due to its varied clinical manifestations, leading to frequent misdiagnosis or delayed intervention. This study aims to assess the clinical presentation, imaging findings, etiologies, and outcomes of childhood stroke in Ethiopia, with a focus on patients admitted to St. Paul's Hospital Millennium Medical College. Methods : A hospital-based, retrospective chart review was conducted. Data were collected from the medical records of patients who were treated at St. Paul's Hospital Millennium Medical College from September 11, 2014, to January 15, 2025 G.C. Results : A total of 44 pediatric stroke cases were analyzed. The most common presenting symptoms were hemiparesis/hemiplegia (79.5%) and seizures (52.3%). Infections were the leading cause (59.1%), followed by cardiac disorders in 13.7% of cases. Ischemic stroke accounted for 70.5% of cases, while hemorrhagic stroke represented 20.4%. MRI was the most frequently used imaging modality (61.3%). At discharge, 81.8% of patients had residual neurological deficits, with motor impairment being the most prevalent (75%). The mortality rate was 9.1%. Hemorrhagic stroke and altered mental status were significant predictors of poor outcomes. Conclusions : Infections, particularly bacterial meningitis, play a crucial role in stroke occurrence in this setting. The high burden of neurological sequelae highlights the importance of early rehabilitation and long-term follow-up. Strengthening pediatric stroke surveillance and optimizing management strategies are essential for improving outcomes in affected children. Pediatric stroke Ethiopia Infection-related stroke Stroke outcomes Figures Figure 1 Figure 2 Figure 3 1. Background Pediatric stroke ranks among the top ten childhood mortality causes globally, with survivors facing significant neurological morbidity.( 1 ) While arteriopathies and cardiac disorders predominate in high-income countries( 2 )( 3 ) etiology varies across regions. No prior studies characterize the clinical profile of childhood stroke in Ethiopia. This study bridges this gap by analyzing the clinical spectrum, etiologies, and outcomes at Ethiopia’s second-largest tertiary hospital. 2. Methods We conducted a retrospective chart review at St. Paul's Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia. Our study aimed to investigate pediatric stroke cases. Data were collected from patient medical records spanning September 11, 2014, to January 15, 2025. All pediatric patients admitted to SPHMMC diagnosed with childhood stroke within the specified time frame were considered for inclusion. We included children between 29 days and 18 years old who had both clinical and radiological evidence of stroke. Cases of perinatal stroke, paraparesis, and paraplegia were excluded. Given the manageable sample size, a comprehensive, purposive sampling approach was used to identify and select all relevant medical records meeting the inclusion criteria. Statistical Analysis Data were collected using a structured checklist adapted from previous studies.( 4 )( 5 )( 6 )( 7 ) Once collected, the data were entered into Excel for cleaning before being exported to SPSS 25 for analysis. The data were coded in SPSS, and results were compiled using frequency tables, figures and pie charts. 3. Results 3.1. Socio-demographic Characteristics A total of 44 patients with childhood stroke were included in the study. The gender distribution showed that 43.2% (19 patients) were male, while 56.8% (25 patients) were female. Regarding residence, a significant majority, 81.8% (36 patients), resided in urban areas, while only 18.2% (8 patients) were from rural areas. The mean age of the patients was 58.52 months, with a standard deviation of 55.273 months, ranging from 3 to 204 month. (Figure 1) 3.2. Clinical Presentation of Childhood Stroke The most common clinical presentation was hemiparesis/hemiplegia, present in 79.5% (35 patients). Seizures were found in 52.3% (23 patients), with focal seizures observed in 60.9% (14 of these patients). Altered consciousness was noted in 27.3% (12 patients). Among these, 9.1% (4 patients) presented with severely impaired consciousness, as indicated by a GCS of 3-8. CN abnormality was also observed in 27.3% (12 patients). Visual and speech disturbances were each observed in 6.8% (3 patients). Additional associated symptoms observed with significant frequency included fever (65.9%, 29 patients), vomiting (63.6%, 28 patients), and headache (36.4%, 16 patients).(Table 1) Other associated symptoms reported were varied and included bilateral thigh swelling, cough, shortness of breath, diarrhea, difficulty swallowing, upper respiratory tract infection (URTI) symptoms, fecal and urinary incontinence, irritability, loss of appetite, quadriparesis, pain, tingling and burning sensations, and trauma. Table 1: Clinical Presentation of Childhood Stroke 3.3. Etiology of Childhood Stroke The etiologic factors identified were diverse. Infections were the most common cause, present in 59.1% (26 patients), with bacterial meningitis seen in 43.2% (19 patients). Other etiologic factors included cardiac disorders (13.6%, 6 patients), with acquired heart disease and congenital heart disease accounting for 11.3% and 2.3% respectively. Arteriopathies accounted for 13.6% (6 patients), with infectious arteriopathies comprising 8.9% and Moyamoya arteriopathy 4.6%. Among hematologic abnormalities, isolated iron deficiency anemia was identified in 4.6% (2 patients), and bleeding disorders were observed in 2.3% (1 case). In 22.7% (10 patients) of the cases, the underlying etiology remained undetermined. Additional conditions noted included arteriovenous malformation, metabolic syndrome (dyslipidemia with hypertension), and malnutrition (under nutrition, obesity).(Table 2) Table 2: Etiology of Childhood Stroke Etiology of Childhood Stroke Frequency (N) Percent (%) Infections 26 59.1 Bacterial meningitis 19 43.2 Viral meningioencephalities 6 13.6 TB meningitis 1 2.3 RVI 1 2.3 Sepsis 1 2.3 Brain abscess 1 2.3 Acute otitis media 1 2.3 Congenital heart disease 1 2.3 Acquired heart disease 5 11.4 Arteropathies 6 13.6 Infectious arteropathies Bacterial 2 4.6 HIV 1 2.3 Viral 1 2.3 Moyamoya Moyamoya Disease 1 2.3 Moyamoya Syndrome 1 2.3 Isolated Iron deficiency anaemia 2 4.6 Bleeding disorder 1 2.3 AV malformation 1 2.3 Metabolic-syndrome Dyslipidemia with hypertension 1 2.3 History of preceeding illness Preceding acute infectious disease 1 2.3 Known chronic illness 6 13.6 Malnutrition Normal 36 81.8 Under nutrition 7 15.9 Obesity 1 2.3 Undetermined etiology 10 22.7 3.4. Imaging Modalities Used and Types of Stroke Neuroimaging was performed in all cases, with MRI being the most frequently used modality (61.3%), followed by CT scans (45.5%). MRV/MRA was used in 11.3% of cases. Other imaging techniques included carotid Doppler study at 4.5% and TF ultrasound at 2.3%. More than one imaging technique was employed for 25% of the patients (11 individuals). The most common type of stroke was ischemic, observed in 75% (33 patients), with infarctions predominantly located in the cortical regions (70.5%). Hemorrhagic strokes were less commonly seen, with 20.4% experiencing intracerebral hemorrhage (ICH). Stroke location based on arterial circulation showed that the middle cerebral artery (MCA) territory was most commonly affected (45.5%), followed by the anterior cerebral artery (ACA) territory (6.8%), posterior cerebral artery (PCA) territory (4.5%), and multiple territories involving branches of the internal carotid artery (ICA) (15.9%). In terms of venous circulation, superior sagittal venous thrombosis (SSVT) was present in 13.6% of cases, transverse sinus venous thrombosis in 6.8%, and deep sagittal venous thrombosis (DSVT) in 4.5%. (Figure 2 and 3) 3.5. Patient Outcome at Discharge and Complications At discharge, 90.9% (40 patients) were discharged with one or more neurologic complications, while 9.1% (4 patients) died. Neurological complications included motor deficits in 75% (33 patients), post-stroke epilepsy (47.7%), cognitive impairment (9.1%), CN abnormality, and speech disturbance (each 6.8%). Additional neurological complications reported were visual disturbance and behavioral abnormalities.(Table 3) Table 3: Patient Outcome at Discharge and Complications Patient Outcome at Discharge and Complications Frequency (N) Percent (%) Outcome of the patient at discharge Discharge Death 40 4 90.9 9.1 Neurologic complications at discharge Motor deficit Cognitive impairment Post-stroke epilepsy CN abnormality Speech disturbance Visual disturbance More than one neurologic complication 35 4 21 3 3 2 23 81.8 9.1 47.7 6.8 6.8 4.6 52.3 3.6. Factors Associated with Childhood Stroke Outcome Linear regression analysis was performed to evaluate the predictive power of independent variables such as age, neurological complications, and stroke types on patient outcomes at discharge (Death and neurological complications). Statistical metrics, including Pearson correlations, R-squared (R2), and significance levels (p-values), were used to assess the strength of these relationships. The analysis revealed that age does not significantly predict mortality or neurological complications at discharge in pediatric stroke cases. The weak correlations and non-significant regression models indicate that age alone is an inadequate predictor of outcomes. This finding underscores the complexity of mortality and neurologic outcomes in pediatric stroke, suggesting the influence of other factors beyond age. Among neurological variables, only altered mentation emerged as a significant predictor of both mortality and neurological complications at discharge, with a p-value of 0.001 in both cases. This result highlights altered mentation as a critical indicator of adverse outcomes in pediatric stroke. Conversely, hemiparesis and seizure did not demonstrate significant associations with either mortality or neurological complications, indicating their limited independent prognostic value. Regarding stroke types, hemorrhagic stroke was a strong predictor of mortality, with a p-value of 0.000, indicating a significantly increased risk of death in patients with this condition. However, other stroke types, including arterial ischemic stroke, cerebral sinus venous thrombosis, and acute ischemic stroke with hemorrhagic transformation, were not significant predictors of mortality. Similarly, hemorrhagic stroke exhibited a stronger association with neurological complications at discharge compared to other stroke types, emphasizing its severity and the need for targeted clinical interventions. 4. Discussion This study explored the clinical features, causes, and outcomes of childhood stroke at the Department of Pediatrics and Child Health, St. Paul’s Hospital Millennium Medical College. A total of 44 pediatric stroke cases were reviewed. The clinical presentation largely matched global data, with hemiparesis or hemiplegia being the most common symptom (79.5%), consistent with studies from the U.S. (49–72%), U.K. (68%), North India (75%), and Yemen (67.5%).( 5 )( 8 )( 6 )( 9 ) This suggests that despite geographic differences, pediatric stroke often presents with similar neurological deficits. Seizures were also common (52.3%), comparable to studies from North India (58%) and Yemen (52%)( 9 )( 6 ) but higher than Taiwan (25.4%)( 1 ). This discrepancy may be due to the younger average age in our cohort and the higher prevalence of infections, which increase seizure susceptibility through neuro-inflammation, fever, and metabolic disturbance. Other frequent symptoms included fever (65.9%), vomiting (63.6%), and headaches (36.4%). The high prevalence of fever—more than in studies from developed countries—likely reflects the high rate of infection-related strokes in our setting. Infections were the leading cause of stroke (59.1%), especially bacterial meningitis (43.2%). This mirrors findings from other low- and middle-income countries (LMICs) like Yemen and North India ( 6 )( 9 ). In contrast, studies in high-income countries more commonly report arteriopathies and cardiac conditions as dominant etiologies ( 10 )( 11 ). Cardiac disorders accounted for 13.7% of cases—comparable to Korea (17.4%) and the U.K. (31%), but lower than West Virginia (42% in neonates) ( 11 )( 8 )( 5 ). Limited access to cardiac diagnostics may explain this underrepresentation in our cohort. Arteriopathies were observed in 13.6% of cases. Moyamoya disease and syndrome together made up 4.6%. This is lower than the U.K. (53%) and Korea (30.6%) but comparable to Kenya (9.4%) ( 5 )( 11 )( 4 ), potentially due to limited availability of advanced imaging like MRA/MRV, used in only 11.3% of cases here. MRI was the most commonly used imaging modality (61.3%), similar to U.K. practices, while CT remains the preferred first-line imaging in countries like India and Kenya( 4 )( 9 )( 10 ) . Ischemic stroke was the dominant subtype (70.5%), aligning with global and regional trends. Hemorrhagic stroke was less common (20.4%) but still significant—higher than in the U.K. (10–20%) but comparable to Taiwan and North India. In LMICs, hemorrhagic strokes are often infection-related or due to unrecognized hematological disorders ( 10 )( 1 )( 4 )( 9 )( 6 ). At discharge, 81.8% of patients had neurological sequelae, mainly motor deficits (75%) and post-stroke epilepsy (47.7%). This is higher than reported in Jordan (58.3%) and Hong Kong (34%), likely due to differences in the timing of follow-up and clinical resources ( 12 )( 13 ). Mortality was 9.1%, lower than rates in Yemen (20%), North India (12%), and China (27.6% for hemorrhagic stroke) ( 13 )( 9 )( 6 ). However, this figure might underestimate actual mortality due to missing records and poor documentation in our system. Regression analysis identified altered mental status as a significant predictor of both mortality and complications (p = 0.001), consistent with Hong Kong and North India findings ( 13 )( 9 ). Other symptoms, including hemiparesis and seizures, were not significantly predictive. Hemorrhagic stroke strongly predicted poor outcomes (p < 0.001), reinforcing the need for focused care in such cases. Limitation The primary limitation or challenge in this study was data. Despite the requirement for comprehensive and detailed data, it was challenging to find an adequate amount of records due to inaccurate documentation of patient diagnoses in logbooks and missing charts in the chart room. Furthermore, the available data lacked the necessary detail, with findings inadequately documented, and laboratory investigations incomplete and inconsistent in identifying underlying causes. This hindered a deeper understanding of the contextual reality and the ability to conduct a thorough analysis with various variables. Consequently, the study's findings remain limited to indicator level, with difficulties in generalizing results due to sample size and lack of quota diversification. Additionally, the fact that this was a single-centre study further constrained the study's limitations. 5. Conclusions In conclusion, pediatric stroke cases reveal a complex interplay of etiological factors, emphasizing the need for tailored management strategies. The prevalence of long-term deficits and varied regional outcomes underscores the urgency for specialized rehabilitation services and ongoing monitoring for pediatric stroke survivors. Age categories and specific clinical presentations do not independently predict outcomes, highlighting the multifactorial nature of pediatric stroke. Targeted interventions for hemorrhagic strokes are essential, and a comprehensive approach is vital to understand predictors of outcomes in pediatric stroke cases. The high prevalence of infection-related strokes highlights the need for targeted interventions, including early recognition, and treatment of infections, and better access to neuroimaging and stroke-specific care. Strengthening stroke surveillance and establishing specialized pediatric stroke units, could improve early detection and management. For the future, a well-structured prospective study would allow for systematic documentation of clinical findings, investigations, and patient outcomes over time, providing a deeper understanding of the risk factors and prognostic indicators associated with pediatric stroke. Additionally establishing clear protocols for systematic patient evaluation, standardized laboratory workups, and evidence-based treatment pathways can improve early detection, enhance treatment consistency, and lead to better patient outcomes. By addressing these data gaps and implementing guidelines, future research and clinical practice could contribute to more effective management strategies and improved health outcomes for affected children. Abbreviations AIS Acute ischemic stroke HS Hemorrhagic stroke AVMs Arteriovenous malformations MCA Middle cerebral artery ACA Anterior cerebral artery PCA Posterior cerebral artery ICH Intracerebral hemorrhage ICA Internal carotid artery SSVT Superior sagittal venous thrombosis TSVT Transverse sinus venous thrombosis DSVT Deep sagittal venous thrombosis TBM Tuberculosis meningitis CT scan Computed tomography scan MRI Magnetic resonance imaging MRA Magnetic resonance angiography MRV Magnetic resonance venography WHO World Health Organization SPHMMC St. Paul’s Hospital Millennium Medical College IRB Institutional Review Board SPSS Statistical Package for Social Science Declarations Ethics approval and consent to participate: Ethical clearance was obtained from the Institutional Review Board (IRB) of SPHMMC to ensure adherence to ethical guidelines. Since the study was conducted by reviewing medical charts and data was obtained from medical charts, informed consent was waived. However, strict confidentiality measures were implemented to protect each patient's information. Patient names and hospital card numbers were not utilized at any point during the study only codes were used to collect data from charts, and patient information was not shared with any third parties. Availability of data and materials: The datasets generated and/or analysed during the current study consist of retrospective hospital records of children with stroke. These data are not publicly available due to patient privacy and ethical restrictions. De-identified data may be available from the corresponding author on reasonable request and with permission of the institutional ethics committee. Competing interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Funding: This research received no external funding. Author Contributions: Conceptualization, Dr. Endayen Deginet, Dr. Mahlet Getnet and Dr. Ayalew Moges; methodology, Dr. Mahlet Getnet, Dr. Endayen Deginet, and Dr. Ayalew Moges; formal analysis, Dr. Mahlet Getnet; investigation, Dr. Mahlet Getnet, Dr. Endayen Deginet; data curation, Dr. Mahlet Getnet, Dr. Endayen Deginet; writing—original draft preparation, Dr. Mahlet Getnet; writing—review and editing, Dr. Mahlet Getnet, Dr. Endayen Deginet; supervision, Dr. Endayen Deginet and Dr. Ayalew Moges; project administration, Dr. Mahlet Getnet and Dr. Endayen Deginet. Acknowledgments: The authors would like to express our sincere appreciation to St. Paul’s Hospital Millennium Medical College department of Pediatrics and Child Health for granting us the opportunity to carry out this study. References Chiang KL, Cheng CY. Epidemiology, risk factors and characteristics of pediatric stroke: A nationwide population-based study. QJM An Int J Med . 2018;111(7):445–54. Friedman N. Pediatric Stroke: Past, Present and Future. Adv Pediatr [Internet]. 2009;56(1):271–99. Available from: http://dx.doi.org/10.1016/j.yapd.2009.08.003 Roach ES, Riela AR, Wiznitzer M. Stroke in Children: Recognition, Treatment, and Future Directions. 2000;7(4):309–17. Ogeng’O JA, Olabu BO, Mburu AN, Sinkeet SR. Pediatric stroke in an African country. J Pediatr Neurosci. 2010;5(1):22–4. Pergami P, Thayapararajah SW, Seemaladinne N. West Virginia University pediatric stroke registry: Clinical description and risk factors identification in patients from a rural area. Clin Pediatr (Phila). 2015;54(1):40–6. Al-harazi AA, Al-eryani AF, Al-sonboli NN, Al-zoa AM Bin, Al-jaifi NH, Al-awamy LA. Pediatric Stroke : Prevalence , Types , Clinical Presentation , Risk Factors and Outcome in Yemen. 2020;5(5):304–10. Rahim MA, Sinha MK, Das MK, Saha R, Rana A, Basu S. Childhood stroke: A prospective study on risk factors, clinical profile, and short-term outcome in a tertiary care hospital in Eastern India. Sri Lanka J Child Heal. 2023;52(4):437–43. Mallick AA, Ganesan V, Kirkham FJ, Fallon P, Hedderly T, McShane T, et al. Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: A prospective population-based study. Lancet Neurol [Internet]. 2014;13(1):35–43. Available from: http://dx.doi.org/10.1016/S1474-4422(13)70290-4 Sood A, Suthar R, Sahu JK, K. Baranwal A, Saini AG, Saini L, et al. Etiologic Profile of Childhood Stroke from North India: Is It Different from Developed World? J Child Neurol. 2021;36(8):655–63. Mallick AA, O’Callaghan FJK. The epidemiology of childhood stroke. Eur J Paediatr Neurol [Internet]. 2010;14(3):197–205. Available from: http://dx.doi.org/10.1016/j.ejpn.2009.09.006 Lee EH, Yum MS, Ko TS. Risk factors and clinical outcomes of childhood ischemic stroke in a single Korean Tertiary Care Center. J Child Neurol. 2012;27(4):485–91. Masri A, Al-Ammouri I. Clinical presentation, etiology, and outcome of stroke in children: A hospital-based study. Brain Dev [Internet]. 2016;38(2):204–8. Available from: http://dx.doi.org/10.1016/j.braindev.2015.08.007 Chung B, Wong V. Pediatric stroke among Hong Kong Chinese subjects. Pediatrics. 2004;114(2). Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":38640,"visible":true,"origin":"","legend":"\u003cp\u003eSocio-demographic Characteristics\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7723699/v1/2af1d490d59d280c142efcab.png"},{"id":96330514,"identity":"12f7ed9e-1d18-4714-9177-38178b74a8a8","added_by":"auto","created_at":"2025-11-20 00:49:41","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":45153,"visible":true,"origin":"","legend":"\u003cp\u003eImaging modalities used to diagnose stroke\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7723699/v1/e6a509c98b301cb50d982e6c.png"},{"id":96330515,"identity":"e62ba5ac-6150-400a-aa79-444c1e4aaced","added_by":"auto","created_at":"2025-11-20 00:49:41","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":39197,"visible":true,"origin":"","legend":"\u003cp\u003eType of stroke\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7723699/v1/42ef1d477c8aa15d92b05438.png"},{"id":96369221,"identity":"b69206d5-4b7e-49dd-aa36-4522a973099e","added_by":"auto","created_at":"2025-11-20 10:20:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":637551,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7723699/v1/63ae9a7c-7e7b-4e88-94a9-fbd40e367707.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eClinical Profile and Etiology of Pediatric Patients With Stroke at St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia\u003c/p\u003e","fulltext":[{"header":"1. Background","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003ePediatric stroke ranks among the top ten childhood mortality causes globally, with survivors facing significant neurological morbidity.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) While arteriopathies and cardiac disorders predominate in high-income countries(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) etiology varies across regions. No prior studies characterize the clinical profile of childhood stroke in Ethiopia. This study bridges this gap by analyzing the clinical spectrum, etiologies, and outcomes at Ethiopia\u0026rsquo;s second-largest tertiary hospital.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e We conducted a retrospective chart review at St. Paul's Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia. Our study aimed to investigate pediatric stroke cases. Data were collected from patient medical records spanning September 11, 2014, to January 15, 2025. All pediatric patients admitted to SPHMMC diagnosed with childhood stroke within the specified time frame were considered for inclusion. We included children between 29 days and 18 years old who had both clinical and radiological evidence of stroke. Cases of perinatal stroke, paraparesis, and paraplegia were excluded. Given the manageable sample size, a comprehensive, purposive sampling approach was used to identify and select all relevant medical records meeting the inclusion criteria.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStatistical Analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eData were collected using a structured checklist adapted from previous studies.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) Once collected, the data were entered into Excel for cleaning before being exported to SPSS 25 for analysis. The data were coded in SPSS, and results were compiled using frequency tables, figures and pie charts.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e3.1. Socio-demographic Characteristics\u003c/p\u003e\n\u003cp\u003eA total of 44 patients with childhood stroke were included in the study. The gender distribution showed that 43.2% (19 patients) were male, while 56.8% (25 patients) were female. Regarding residence, a significant majority, 81.8% (36 patients), resided in urban areas, while only 18.2% (8 patients) were from rural areas. The mean age of the patients was 58.52 months, with a standard deviation of 55.273 months, ranging from 3 to 204 month. (Figure 1)\u003c/p\u003e\n\u003cp\u003e3.2. Clinical Presentation of Childhood Stroke\u003c/p\u003e\n\u003cp\u003eThe most common clinical presentation was hemiparesis/hemiplegia, present in 79.5% (35 patients). Seizures were found in 52.3% (23 patients), with focal seizures observed in 60.9% (14 of these patients). Altered consciousness was noted in 27.3% (12 patients). Among these, 9.1% (4 patients) presented with severely impaired consciousness, as indicated by a GCS of 3-8. CN abnormality was also observed in 27.3% (12 patients). Visual and speech disturbances were each observed in 6.8% (3 patients). Additional associated symptoms observed with significant frequency included fever (65.9%, 29 patients), vomiting (63.6%, 28 patients), and headache (36.4%, 16 patients).(Table 1)\u003c/p\u003e\n\u003cp\u003eOther associated symptoms reported were varied and included bilateral thigh swelling, cough, shortness of breath, diarrhea, difficulty swallowing, upper respiratory tract infection (URTI) symptoms, fecal and urinary incontinence, irritability, loss of appetite, quadriparesis, pain, tingling and burning sensations, and trauma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 1:\u0026nbsp;\u003c/strong\u003eClinical Presentation of Childhood Stroke\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1763569516.png\" width=\"839\" height=\"829\"\u003e\u003c/p\u003e\n\u003cp\u003e3.3. Etiology of Childhood Stroke\u003c/p\u003e\n\u003cp\u003eThe etiologic factors identified were diverse. Infections were the most common cause, present in 59.1% (26 patients), with bacterial meningitis seen in 43.2% (19 patients). Other etiologic factors included cardiac disorders (13.6%, 6 patients), with acquired heart disease and congenital heart disease accounting for 11.3% and 2.3% respectively. Arteriopathies accounted for 13.6% (6 patients), with infectious arteriopathies comprising 8.9% and Moyamoya arteriopathy 4.6%. Among hematologic abnormalities, isolated iron deficiency anemia was identified in 4.6% (2 patients), and bleeding disorders were observed in 2.3% (1 case). In 22.7% (10 patients) of the cases, the underlying etiology remained undetermined. Additional conditions noted included arteriovenous malformation, metabolic syndrome (dyslipidemia with hypertension), and malnutrition (under nutrition, obesity).(Table 2)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 2:\u0026nbsp;\u003c/strong\u003eEtiology of Childhood Stroke\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"583\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 194px;\"\u003eEtiology of Childhood Stroke\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 33.7907%;\"\u003eFrequency (N)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 37.7358%;\"\u003ePercent (%)\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eInfections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e59.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eBacterial meningitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e43.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eViral meningioencephalities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eTB meningitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eRVI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eSepsis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eBrain abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eAcute otitis media\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eCongenital heart disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eAcquired heart disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eArteropathies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eInfectious arteropathies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eBacterial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eViral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eMoyamoya\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eMoyamoya Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eMoyamoya Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eIsolated Iron deficiency anaemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eBleeding disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eAV malformation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eMetabolic-syndrome Dyslipidemia with hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eHistory of preceeding illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003ePreceding acute infectious disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eKnown chronic illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eMalnutrition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e81.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eUnder nutrition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eObesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eUndetermined etiology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e22.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003e3.4. Imaging Modalities Used and Types of Stroke\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNeuroimaging was performed in all cases, with MRI being the most frequently used modality (61.3%), followed by CT scans (45.5%). MRV/MRA was used in 11.3% of cases. Other imaging techniques included carotid Doppler study at 4.5% and TF ultrasound at 2.3%. More than one imaging technique was employed for 25% of the patients (11 individuals). The most common type of stroke was ischemic, observed in 75% (33 patients), with infarctions predominantly located in the cortical regions (70.5%). Hemorrhagic strokes were less commonly seen, with 20.4% experiencing intracerebral hemorrhage (ICH). Stroke location based on arterial circulation showed that the middle cerebral artery (MCA) territory was most commonly affected (45.5%), followed by the anterior cerebral artery (ACA) territory (6.8%), posterior cerebral artery (PCA) territory (4.5%), and multiple territories involving branches of the internal carotid artery (ICA) (15.9%). In terms of venous circulation, superior sagittal venous thrombosis (SSVT) was present in 13.6% of cases, transverse sinus venous thrombosis in 6.8%, and deep sagittal venous thrombosis (DSVT) in 4.5%. (Figure 2 and 3)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.5. Patient Outcome at Discharge and Complications\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAt discharge, 90.9% (40 patients) were discharged with one or more neurologic complications, while 9.1% (4 patients) died. Neurological complications included motor deficits in 75% (33 patients), post-stroke epilepsy (47.7%), cognitive impairment (9.1%), CN abnormality, and speech disturbance (each 6.8%). Additional neurological complications reported were visual disturbance and behavioral abnormalities.(Table 3)\u003c/p\u003e\n\u003cp\u003eTable 3: Patient Outcome at Discharge and Complications\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"524\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient Outcome at Discharge and Complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003eFrequency (N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003ePercent (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003eOutcome of the patient at discharge\u003c/p\u003e\n \u003cp\u003eDischarge\u003c/p\u003e\n \u003cp\u003eDeath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e90.9\u003c/p\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003eNeurologic complications at discharge\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMotor deficit\u003c/p\u003e\n \u003cp\u003eCognitive impairment\u003c/p\u003e\n \u003cp\u003ePost-stroke epilepsy\u003c/p\u003e\n \u003cp\u003eCN abnormality\u003c/p\u003e\n \u003cp\u003eSpeech disturbance\u003c/p\u003e\n \u003cp\u003eVisual disturbance\u003c/p\u003e\n \u003cp\u003eMore than one neurologic complication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e81.8\u003c/p\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003cp\u003e47.7\u003c/p\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003cp\u003e52.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e3.6. Factors Associated with Childhood Stroke Outcome\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eLinear regression analysis was performed to evaluate the predictive power of independent variables such as age, neurological complications, and stroke types on patient outcomes at discharge (Death and neurological complications). Statistical metrics, including Pearson correlations, R-squared (R2), and significance levels (p-values), were used to assess the strength of these relationships.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe analysis revealed that age does not significantly predict mortality or neurological complications at discharge in pediatric stroke cases. The weak correlations and non-significant regression models indicate that age alone is an inadequate predictor of outcomes. This finding underscores the complexity of mortality and neurologic outcomes in pediatric stroke, suggesting the influence of other factors beyond age. Among neurological variables, only altered mentation emerged as a significant predictor of both mortality and neurological complications at discharge, with a p-value of 0.001 in both cases. This result highlights altered mentation as a critical indicator of adverse outcomes in pediatric stroke. Conversely, hemiparesis and seizure did not demonstrate significant associations with either mortality or neurological complications, indicating their limited independent prognostic value.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding stroke types, hemorrhagic stroke was a strong predictor of mortality, with a p-value of 0.000, indicating a significantly increased risk of death in patients with this condition. However, other stroke types, including arterial ischemic stroke, cerebral sinus venous thrombosis, and acute ischemic stroke with hemorrhagic transformation, were not significant predictors of mortality. Similarly, hemorrhagic stroke exhibited a stronger association with neurological complications at discharge compared to other stroke types, emphasizing its severity and the need for targeted clinical interventions.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThis study explored the clinical features, causes, and outcomes of childhood stroke at the Department of Pediatrics and Child Health, St. Paul\u0026rsquo;s Hospital Millennium Medical College. A total of 44 pediatric stroke cases were reviewed.\u003c/p\u003e\u003cp\u003eThe clinical presentation largely matched global data, with hemiparesis or hemiplegia being the most common symptom (79.5%), consistent with studies from the U.S. (49\u0026ndash;72%), U.K. (68%), North India (75%), and Yemen (67.5%).(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) This suggests that despite geographic differences, pediatric stroke often presents with similar neurological deficits.\u003c/p\u003e\u003cp\u003eSeizures were also common (52.3%), comparable to studies from North India (58%) and Yemen (52%)(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) but higher than Taiwan (25.4%)(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This discrepancy may be due to the younger average age in our cohort and the higher prevalence of infections, which increase seizure susceptibility through neuro-inflammation, fever, and metabolic disturbance.\u003c/p\u003e\u003cp\u003eOther frequent symptoms included fever (65.9%), vomiting (63.6%), and headaches (36.4%). The high prevalence of fever\u0026mdash;more than in studies from developed countries\u0026mdash;likely reflects the high rate of infection-related strokes in our setting.\u003c/p\u003e\u003cp\u003eInfections were the leading cause of stroke (59.1%), especially bacterial meningitis (43.2%). This mirrors findings from other low- and middle-income countries (LMICs) like Yemen and North India (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In contrast, studies in high-income countries more commonly report arteriopathies and cardiac conditions as dominant etiologies (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCardiac disorders accounted for 13.7% of cases\u0026mdash;comparable to Korea (17.4%) and the U.K. (31%), but lower than West Virginia (42% in neonates) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Limited access to cardiac diagnostics may explain this underrepresentation in our cohort.\u003c/p\u003e\u003cp\u003eArteriopathies were observed in 13.6% of cases. Moyamoya disease and syndrome together made up 4.6%. This is lower than the U.K. (53%) and Korea (30.6%) but comparable to Kenya (9.4%) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), potentially due to limited availability of advanced imaging like MRA/MRV, used in only 11.3% of cases here.\u003c/p\u003e\u003cp\u003eMRI was the most commonly used imaging modality (61.3%), similar to U.K. practices, while CT remains the preferred first-line imaging in countries like India and Kenya(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) .\u003c/p\u003e\u003cp\u003eIschemic stroke was the dominant subtype (70.5%), aligning with global and regional trends. Hemorrhagic stroke was less common (20.4%) but still significant\u0026mdash;higher than in the U.K. (10\u0026ndash;20%) but comparable to Taiwan and North India. In LMICs, hemorrhagic strokes are often infection-related or due to unrecognized hematological disorders (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAt discharge, 81.8% of patients had neurological sequelae, mainly motor deficits (75%) and post-stroke epilepsy (47.7%). This is higher than reported in Jordan (58.3%) and Hong Kong (34%), likely due to differences in the timing of follow-up and clinical resources (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMortality was 9.1%, lower than rates in Yemen (20%), North India (12%), and China (27.6% for hemorrhagic stroke) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). However, this figure might underestimate actual mortality due to missing records and poor documentation in our system.\u003c/p\u003e\u003cp\u003eRegression analysis identified altered mental status as a significant predictor of both mortality and complications (p\u0026thinsp;=\u0026thinsp;0.001), consistent with Hong Kong and North India findings (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Other symptoms, including hemiparesis and seizures, were not significantly predictive. Hemorrhagic stroke strongly predicted poor outcomes (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), reinforcing the need for focused care in such cases.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe primary limitation or challenge in this study was data. Despite the requirement for comprehensive and detailed data, it was challenging to find an adequate amount of records due to inaccurate documentation of patient diagnoses in logbooks and missing charts in the chart room. Furthermore, the available data lacked the necessary detail, with findings inadequately documented, and laboratory investigations incomplete and inconsistent in identifying underlying causes. This hindered a deeper understanding of the contextual reality and the ability to conduct a thorough analysis with various variables. Consequently, the study's findings remain limited to indicator level, with difficulties in generalizing results due to sample size and lack of quota diversification. Additionally, the fact that this was a single-centre study further constrained the study's limitations.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIn conclusion, pediatric stroke cases reveal a complex interplay of etiological factors, emphasizing the need for tailored management strategies. The prevalence of long-term deficits and varied regional outcomes underscores the urgency for specialized rehabilitation services and ongoing monitoring for pediatric stroke survivors. Age categories and specific clinical presentations do not independently predict outcomes, highlighting the multifactorial nature of pediatric stroke. Targeted interventions for hemorrhagic strokes are essential, and a comprehensive approach is vital to understand predictors of outcomes in pediatric stroke cases.\u003c/p\u003e\u003cp\u003eThe high prevalence of infection-related strokes highlights the need for targeted interventions, including early recognition, and treatment of infections, and better access to neuroimaging and stroke-specific care. Strengthening stroke surveillance and establishing specialized pediatric stroke units, could improve early detection and management.\u003c/p\u003e\u003cp\u003eFor the future, a well-structured prospective study would allow for systematic documentation of clinical findings, investigations, and patient outcomes over time, providing a deeper understanding of the risk factors and prognostic indicators associated with pediatric stroke. Additionally establishing clear protocols for systematic patient evaluation, standardized laboratory workups, and evidence-based treatment pathways can improve early detection, enhance treatment consistency, and lead to better patient outcomes. By addressing these data gaps and implementing guidelines, future research and clinical practice could contribute to more effective management strategies and improved health outcomes for affected children.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAIS Acute ischemic stroke\u003c/p\u003e\n\u003cp\u003eHS Hemorrhagic stroke\u003c/p\u003e\n\u003cp\u003eAVMs Arteriovenous malformations\u003c/p\u003e\n\u003cp\u003eMCA Middle cerebral artery \u003c/p\u003e\n\u003cp\u003eACA Anterior cerebral artery \u003c/p\u003e\n\u003cp\u003ePCA Posterior cerebral artery\u003c/p\u003e\n\u003cp\u003eICH Intracerebral hemorrhage\u003c/p\u003e\n\u003cp\u003eICA Internal carotid artery \u003c/p\u003e\n\u003cp\u003eSSVT Superior sagittal venous thrombosis \u003c/p\u003e\n\u003cp\u003eTSVT Transverse sinus venous thrombosis \u003c/p\u003e\n\u003cp\u003eDSVT Deep sagittal venous thrombosis \u003c/p\u003e\n\u003cp\u003eTBM Tuberculosis meningitis \u003c/p\u003e\n\u003cp\u003eCT scan Computed tomography scan \u003c/p\u003e\n\u003cp\u003eMRI Magnetic resonance imaging\u003c/p\u003e\n\u003cp\u003eMRA Magnetic resonance angiography\u003c/p\u003e\n\u003cp\u003eMRV Magnetic resonance venography\u003c/p\u003e\n\u003cp\u003eWHO World Health Organization\u003c/p\u003e\n\u003cp\u003eSPHMMC St. Paul\u0026rsquo;s Hospital Millennium Medical College \u003c/p\u003e\n\u003cp\u003eIRB Institutional Review Board \u003c/p\u003e\n\u003cp\u003eSPSS Statistical Package for Social Science\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eEthical clearance was obtained from the Institutional Review Board (IRB) of SPHMMC to ensure adherence to ethical guidelines. Since the study was conducted by reviewing medical charts and data was obtained from medical charts, informed consent was waived. However, strict confidentiality measures were implemented to protect each patient\u0026apos;s information. Patient names and hospital card numbers were not utilized at any point during the study only codes were used to collect data from charts, and patient information was not shared with any third parties. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets generated and/or analysed during the current study consist of retrospective hospital records of children with stroke. These data are not publicly available due to patient privacy and ethical restrictions. De-identified data may be available from the corresponding author on reasonable request and with permission of the institutional ethics committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e Conceptualization, Dr. Endayen Deginet, Dr. Mahlet Getnet and Dr. Ayalew Moges; methodology, Dr. Mahlet Getnet, Dr. Endayen Deginet, and Dr. Ayalew Moges; formal analysis, Dr. Mahlet Getnet; investigation, Dr. Mahlet Getnet, Dr. Endayen Deginet; data curation, Dr. Mahlet Getnet, Dr. Endayen Deginet; writing\u0026mdash;original draft preparation, Dr. Mahlet Getnet; writing\u0026mdash;review and editing, Dr. Mahlet Getnet, Dr. Endayen Deginet; supervision, Dr. Endayen Deginet and Dr. Ayalew Moges; project administration, Dr. Mahlet Getnet and Dr. Endayen Deginet.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e The authors would like to express our sincere appreciation to St. Paul\u0026rsquo;s Hospital Millennium Medical College department of Pediatrics and Child Health for granting us the opportunity to carry out this study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli dir=\"LTR\"\u003eChiang KL, Cheng CY. Epidemiology, risk factors and characteristics of pediatric stroke: A nationwide population-based study. QJM An Int J Med . 2018;111(7):445\u0026ndash;54. \u003c/li\u003e\n \u003cli dir=\"LTR\"\u003eFriedman N. Pediatric Stroke: Past, Present and Future. Adv Pediatr [Internet]. 2009;56(1):271\u0026ndash;99. Available from: http://dx.doi.org/10.1016/j.yapd.2009.08.003\u003c/li\u003e\n \u003cli dir=\"LTR\"\u003eRoach ES, Riela AR, Wiznitzer M. Stroke in Children: Recognition, Treatment, and Future Directions. 2000;7(4):309\u0026ndash;17. \u003c/li\u003e\n \u003cli dir=\"LTR\"\u003eOgeng\u0026rsquo;O JA, Olabu BO, Mburu AN, Sinkeet SR. Pediatric stroke in an African country. J Pediatr Neurosci. 2010;5(1):22\u0026ndash;4. \u003c/li\u003e\n \u003cli dir=\"LTR\"\u003ePergami P, Thayapararajah SW, Seemaladinne N. West Virginia University pediatric stroke registry: Clinical description and risk factors identification in patients from a rural area. Clin Pediatr (Phila). 2015;54(1):40\u0026ndash;6. \u003c/li\u003e\n \u003cli dir=\"LTR\"\u003eAl-harazi AA, Al-eryani AF, Al-sonboli NN, Al-zoa AM Bin, Al-jaifi NH, Al-awamy LA. Pediatric Stroke : Prevalence , Types , Clinical Presentation , Risk Factors and Outcome in Yemen. 2020;5(5):304\u0026ndash;10. \u003c/li\u003e\n \u003cli dir=\"LTR\"\u003eRahim MA, Sinha MK, Das MK, Saha R, Rana A, Basu S. Childhood stroke: A prospective study on risk factors, clinical profile, and short-term outcome in a tertiary care hospital in Eastern India. Sri Lanka J Child Heal. 2023;52(4):437\u0026ndash;43. \u003c/li\u003e\n \u003cli dir=\"LTR\"\u003eMallick AA, Ganesan V, Kirkham FJ, Fallon P, Hedderly T, McShane T, et al. Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: A prospective population-based study. Lancet Neurol [Internet]. 2014;13(1):35\u0026ndash;43. Available from: http://dx.doi.org/10.1016/S1474-4422(13)70290-4\u003c/li\u003e\n \u003cli dir=\"LTR\"\u003eSood A, Suthar R, Sahu JK, K. Baranwal A, Saini AG, Saini L, et al. Etiologic Profile of Childhood Stroke from North India: Is It Different from Developed World? J Child Neurol. 2021;36(8):655\u0026ndash;63. \u003c/li\u003e\n \u003cli dir=\"LTR\"\u003e Mallick AA, O\u0026rsquo;Callaghan FJK. The epidemiology of childhood stroke. Eur J Paediatr Neurol [Internet]. 2010;14(3):197\u0026ndash;205. Available from: http://dx.doi.org/10.1016/j.ejpn.2009.09.006\u003c/li\u003e\n \u003cli dir=\"LTR\"\u003e Lee EH, Yum MS, Ko TS. Risk factors and clinical outcomes of childhood ischemic stroke in a single Korean Tertiary Care Center. J Child Neurol. 2012;27(4):485\u0026ndash;91. \u003c/li\u003e\n \u003cli dir=\"LTR\"\u003e Masri A, Al-Ammouri I. Clinical presentation, etiology, and outcome of stroke in children: A hospital-based study. Brain Dev [Internet]. 2016;38(2):204\u0026ndash;8. Available from: http://dx.doi.org/10.1016/j.braindev.2015.08.007\u003c/li\u003e\n \u003cli dir=\"LTR\"\u003e Chung B, Wong V. Pediatric stroke among Hong Kong Chinese subjects. Pediatrics. 2004;114(2). \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pediatric stroke, Ethiopia, Infection-related stroke, Stroke outcomes","lastPublishedDoi":"10.21203/rs.3.rs-7723699/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7723699/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground/Objectives\u003c/strong\u003e: Pediatric stroke, though rare, remains a significant cause of morbidity and mortality in children. The condition presents a diagnostic challenge due to its varied clinical manifestations, leading to frequent misdiagnosis or delayed intervention. This study aims to assess the clinical presentation, imaging findings, etiologies, and outcomes of childhood stroke in Ethiopia, with a focus on patients admitted to St. Paul's Hospital Millennium Medical College.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A hospital-based, retrospective chart review was conducted. Data were collected from the medical records of patients who were treated at St. Paul's Hospital Millennium Medical College from September 11, 2014, to January 15, 2025 G.C.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A total of 44 pediatric stroke cases were analyzed. The most common presenting symptoms were hemiparesis/hemiplegia (79.5%) and seizures (52.3%). Infections were the leading cause (59.1%), followed by cardiac disorders in 13.7% of cases. Ischemic stroke accounted for 70.5% of cases, while hemorrhagic stroke represented 20.4%. MRI was the most frequently used imaging modality (61.3%). At discharge, 81.8% of patients had residual neurological deficits, with motor impairment being the most prevalent (75%). The mortality rate was 9.1%. Hemorrhagic stroke and altered mental status were significant predictors of poor outcomes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Infections, particularly bacterial meningitis, play a crucial role in stroke occurrence in this setting. The high burden of neurological sequelae highlights the importance of early rehabilitation and long-term follow-up. Strengthening pediatric stroke surveillance and optimizing management strategies are essential for improving outcomes in affected children.\u003c/p\u003e","manuscriptTitle":"Clinical Profile and Etiology of Pediatric Patients With Stroke at St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-20 00:49:36","doi":"10.21203/rs.3.rs-7723699/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"309631037226075983977373490603928616616","date":"2025-11-20T03:56:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-19T06:18:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"140810047749356266020763516574483789863","date":"2025-11-13T10:48:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"61666703138448275711079283421433479611","date":"2025-11-12T06:52:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"265027314741437331790732565873155696024","date":"2025-11-10T10:41:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-10T05:54:29+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-13T19:48:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-13T09:31:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-13T09:29:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-09-26T16:31:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d1912ccc-bc93-4521-9558-2ed617243a2f","owner":[],"postedDate":"November 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-20T00:49:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-20 00:49:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7723699","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7723699","identity":"rs-7723699","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}