Multifactorial Nature of Childhood Stroke Presents a Major Challenge for Diagnosis and Management: A Population‐Based Study From Southern Finland

Aim Childhood ischemic stroke is rare but causes substantial long‐term morbidity, and its heterogeneous aetiology complicates timely diagnosis and management. Methods We conducted a retrospective population‐based observational study using hospital data and chart review to describe diagnostics, treatment and outcomes of ischemic stroke in patients aged 1 month to 18 years treated at HUS Helsinki University Hospital between 2010 and 2023. Hemorrhagic strokes were excluded. Results Among 137 patients, the median annual incidence was 2.5 per 100 000 children. The five largest aetiological subgroups were idiopathic (18%), arteriopathy (16%), major surgery (13%), cardiac embolism (13%) and infection (12%). More than half of patients with available data were diagnosed more than 24 h after symptom onset. Hemiplegia was the most frequent symptom (44%), followed by seizures (25%), which were particularly common in infants. At follow‐up, about half of the patients had motor and/or neuropsychological deficits. Epilepsy developed in 20 (15%) patients and recurrent stroke occurred in 8 (6%). Conclusion Childhood ischemic strokes in our population had heterogeneous causes and substantial long‐term morbidity. Diagnostic delays were frequent, underscoring the need to improve recognition of paediatric stroke. The low recurrence rate highlights the importance of population‐specific factors when interpreting risk and outcomes.