Delay in the Diagnosis of Ischemic Stroke in Early Childhood: Results of a Pilot Assessment of Clinical and Neuroimaging Data

Data on delays in the diagnosis of ischemic stroke (IS) in children are practically absent in Russian cohorts. The aim of this study was to assess the time to diagnosis of IS in early childhood patients at the children’s hospital (Ekaterinburg). Materials and methods. Twenty-four children aged 0–36 months with a confirmed diagnosis of ischemic stroke were retrospectively evaluated based on medical records, assessing the following time intervals: “disease onset to hospitalization”, “disease onset to first neuroimaging”, “hospitalization to first neuroimaging” and “disease onset to diagnosis”. The first symptom of stroke and the presence of infarction on neuroimaging were also recorded. Results. The first symptom of stroke in children was limb paresis in 58 % of cases. A correct referral diagnosis at hospital admission was made in 63 % of cases. In 7 children (29 %), cranial ultrasound preceded computed tomography or magnetic resonance imaging. According to CT data, the lesion was visible in 75 % of patients. The mean times were: “disease onset to hospitalization” — (25.5±40.7) hours; “disease onset to first neuroimaging” — (38.7±50.5) hours; “hospitalization to first neuroimaging” — (13.2±33.6) hours; “disease onset to diagnosis” — (58.3±82.9) hours. Conclusion. Early childhood remains a challenging period for the accurate recognition of ischemic stroke, due to low clinical suspicion among emergency physicians, inappropriate choice of neuroimaging methods, frequent presentation with nonspecific cerebral symptoms, and the inability to fully communicate with children because of their age.