• Henry H Cheng, Satish Rajagopal, Erica McDavitt, Daniel Wigmore, Kathryn Williams, Ravi Thiagarajan, P Ellen Grant, Amy Danehy, and Michael J Rivkin.
• 1Department of Cardiology, Boston Children's Hospital, Boston, MA.2Department of Clinical Research, Boston Children's Hospital, Boston, MA.3Department of Radiology, Boston Children's Hospital, Boston, MA.4Department of Psychiatry, Boston Children's Hospital, Boston, MA.5Department of Neurology, Boston Children's Hospital, Boston, MA.
• Pediatr Crit Care Me. 2016 Oct 1; 17 (10): 976-983.

ObjectiveTo describe strokes in patients with acquired or congenital heart disease and investigate risk factors for in-hospital mortality and ongoing neurologic deficits.DesignSingle-center, retrospective review of cardiac, neurologic, and radiologic patient databases.SettingTertiary care children's hospital.PatientsAll patients with acquired or congenital heart disease admitted from January 2010 to October 2014 identified with stroke.InterventionsNone.Measurements And Main ResultsEighty-four stroke events were identified in 83 patients (median age, 5.9 mo; interquartile range, 0.8-33.4). Thirty-two patients (38%) had single ventricle congenital heart disease. Eight patients (9%) presented with symptoms at home, and the remainder was diagnosed while already admitted to the hospital. Forty patients (48%) presented with clinically evident neurologic deficits (e.g., weakness, seizures). Fifty-eight patients (69%) had arterial ischemic strokes, and 13 (15%) had parenchymal hemorrhages. At diagnosis, 54 patients (64%) were on inotropes. Twenty-nine patients (35%) had greater than or equal to 3 cardiac procedures during their hospitalization before stroke diagnosis. In-hospital mortality occurred in 28 patients (33%). Under multivariate analysis, inotropes, number of cardiac procedures, lack of seizure, and parenchymal hemorrhage were independently associated with in-hospital mortality (p < 0.05). Fifty-four percent of survivors with neurologic follow-up had ongoing neurologic deficits attributable to strokes (median follow-up, 15.3 mo; interquartile range, 7.0-29.9). With multivariate analysis, longer hospital stay (p = 0.02) was independently associated with ongoing deficits.ConclusionsA majority of patients with acquired or congenital heart disease who suffer stroke present while hospitalized and without focal neurologic findings. In-hospital mortality is associated with inotropes, cardiac procedures, lack of seizure, and parenchymal hemorrhage. The majority of survivors have lasting neurologic deficits associated with longer hospital stay.

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