BACKGROUND: A Hong Kong Childhood Stroke Registry (HKCSR) was established for Chinese children. OBJECTIVE: To study the clinical presentation, etiology, risk factors and outcome of Chinese children with stroke….published_or_final_versio

Chung, B

Wong, VCN

Hong Kong Medical Journal

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Title Hong Kong childhood stroke registry (HKCSR) - a study of 50cases (1991-2001)Author(s) Chung, B; Wong, VCNCitationJoint Annual Scientific Meeting of Hong Kong Epilepsy Societyand The Hong Kong Neurological Society, Hong Kong MedicalJournal, Hong Kong, China, 7-9 November 2003, v. 9 n. 6 Supp 2,p. 8-9Issued Date 2003URL http://hdl.handle.net/10722/46990Rights Creative Commons: Attribution 3.0 Hong Kong License8      Hong Kong Med J Vol 9 No 6 December 2003 Supplement 2SYMPOSIUM I – PFIZER SATELLITE SYMPOSIUM ONEPILEPSYEpilepsy Management: Matching Drugs to PatientsMartin J. BrodieEpilepsy UnitUniversity of GlasgowGlasgow, ScotlandThe last 10 years have witnessed the global introduction into clinicalpractice of 9 new antiepileptic drugs (AEDs). These, together withthe established agents, offer substantial choice to doctors treatingpatients with epilepsy. Most patients with recent onset seizureswill be fully controlled with the first or second AED chosen oftenat moderate and even modest dosing. Since most patients diagnosedin adolescence or adulthood will require to take prophylactic AEDtherapy lifelong, it is important also to anticipate unacceptable side-effects and long term sequelae. The substantial choice of AEDsmakes it possible to take a most holistic approach to epilepsymanagement. Consideration should be given to the patient’sseizures and/or epilepsy syndrome, age, gender, weight, co-morbidities, psychiatric history, concomitant medication andlifestyle when starting treatment. An alternative AED should besubstituted if the first is ineffective or poorly tolerated. If twomonotherapies fail or if the first AED produces a substantialimprovement, a second drug with multiple mechanisms of actionshould be added. Attempts at seizure control should be made withtwo or three AEDs but never more. As more novel AEDs becomeavailable, the potential increasingly exists for synergism. A widerange of established and modern AEDs with different mechanismsof action, pharmacokinetics, spectra of efficacy, side-effects andinteraction profiles are now available. We should make an effort tochoose the best monotherapy and combination regimen for eachindividual patient. An aggressive approach to early optimizationof seizure control may prevent the subsequent development ofintractable epilepsy. Nevertheless, there is still a substantialminority of patients who are pharmacoresistant to the current AEDarmamentarium.FREE PAPER PRESENTATIONSRe-exploring the Cerebrospinal Fluid (CSF) toSerum Glucose RatioT. S. Cheng, W. Mak, G. C. Y. Fong, K. L. Tsang, K. H. Chan,R. T. F. Cheung, S. L. HoDivision of Neurology, University Department of Medicine,Queen Mary Hospital, Hong KongBackgroundIn interpretation of lumbar puncture (LP) findings, CSF glucose isconventionally expressed as a ratio to the simultaneous level inserum. A low ratio indicates hypoglycorrhachia and pathologicalconditions.MethodWe retrospectively studied the CSF findings in consecutive LPsperformed in our ward over 5 years. Patients with conditions knownto cause CSF hypoglycorrhacia, uncertain diagnosis and inadequatelaboratory data were excluded. Blood for simultaneous serumglucose level was sampled within one hour of LP. ANOVA,Newman-Keuls multiple comparisons test and linear regressionwere used for statistical analysis.Results170 sets of samples from patients with central demyelination (45),neuropathies (66), headache (26), normal pressure hydrocephalus(11), neurodegenerative diseases (8), and others conditions (14)were studied. CSF glucose was <2.2 mmol/L in only one sample.Mean CSF to serum glucose ratio was 0.61 (range 0.21-1.00).Proportion of samples with ratios of <0.50, 0.50-0.59, 0.60-0.69and ≥0.70 were 18.8, 27.1, 29.4 and 24.7% for all patients, and6.8, 27.3, 38.6 and 27.3%, 60.0, 24.0, 8.0 and 8.0%, or 61.5, 30.8,0.0 and 7.7% for patients with simultaneous serum glucose of< 7.8, 7.8-11.1 or >11.1 mmol/L, respectively. Mean CSF to serumglucose ratios were significantly different between patientswith simultaneous serum glucose of <7.8, 7.8-11.1 and >11.1mmol/L (P <0.0001), but not for different neurological conditions(P = 0.5911). Linear regression showed a significant relationbetween serum and CSF glucose (r = 0.769, P <0.0001) and inversecorrelation between serum glucose and CSF to serum glucoseratio (r = -0.569, P <0.0001, y = 0.8 - 0.03x).ConclusionsOur study demonstrates the CSF to serum glucose ratio is notconstantly related to but varies inversely with the simultaneousserum glucose level. A significant proportion of patients withoutconditions causing CSF hypoglycorrhachia has a low ratioduring hyperglycaemia. The coefficient derived from our linear re-gression model can be applied for adjustment of such deviations.Prestroke Cognitive Impairment in StrokeAssociated with Small Vessel DiseaseV. C. T. Mok, W. K. Tang, H. M. Wen, A. Wong, L. Baum,C. F. Hui, Y. H. Fan, A. T. Ahuja, W. W. M. Lam, K. S. WongPrince of Wales Hospital, Shatin, Hong KongObjectivesSince in stroke associated with small vessel disease (SSVD),prestroke cognitive decline is associated with post stroke dementia,we studied the frequency, determinants, and outcome of prestrokecognitive impairment in SSVD.MethodsOver a 6 months period, we administered Informant Questionnaireon Cognitive Decline (IQCODE) to close informants of 78 patientswho were consecutively admitted to the acute stroke unit within 1week of admission because of SSVD. Demographic data, vascularrisk factors, apolipoprotein E, neuroimaging features (volume ofwhite matter changes, number of silent small infarcts, cerebralatrophy index [CAI]), and outcome (stroke severity, cognition,Barthel index [BI], instrumental activities of daily living [IADL])were compared between those with (IQCODE >/= 3.4) andwithout (IQCODE < 3.4) prestroke cognitive impairment.Regression analysis was performed to find predictors ofprestroke cognitive impairment.ResultsNineteen patients (24.4%) had prestroke cognitive impairment.Multivariate regression revealed that only CAI (OR 1.48, CI 1.17to 1.86, p<0.001) predicted prestroke cognitive impairment.Patients with prestroke cognitive impairment had greaterimpairment in cognition and IADL than those without it despiteboth groups having similar stroke severity and BI.ConclusionOne quarter of patients with SSVD have prestroke cognitiveimpairment. Cerebral atrophy is associated with prestroke cognitiveimpairment. Those with prestroke cognitive impairment have moreimpaired post stroke cognition and IADL than those without it.Hong Kong Childhood Stroke Registry (HKCSR) —A Study of 50 Cases (1991-2001)S 1F 1F 2F 3Hong Kong Med J Vol 9 No 6 December 2003 Supplement 2      9B. Chung, V. C. N. WongDepartment of Paediatrics & Adolescent Medicine,The University of Hong Kong, Hong KongBackgroundA Hong Kong Childhood Stroke Registry (HKCSR) wasestablished for Chinese children.ObjectiveTo study the clinical presentation, etiology, risk factors and outcomeof Chinese children with stroke.Materials and MethodsA prospective childhood stroke database was collected during 1991-2001 for children with stroke seen in the University of Hong Kong.Neonatal strokes were excluded.ResultsFifty children (boys: girls = 28: 22) with mean age of 5.4 yearswere included. The commonest presenting features were seizuresand hemiplegia. There were 36 ischemic and 14 haemorrhagicstrokes. For ischemic stroke (36), 18 were due to thrombosis - 11were vascular origin [moya-moya disease (3), neurofibromatosis(2), fibromuscular dysplasia (1) and post-infectious vasculitis (7)];5 were haematological [leukaemia (3); thalassaemia (2)]; and 1each with severe dehydration and Mitochondrial EncephalopathyLactic Acidosis Syndrome. Of 15 cases with embolic stroke, allhad underlying congenital heart diseases. For 14 cases withhaemorrhagic stroke, 2 had arteriovenous malformation, 7 hadbleeding tendency [leukaemia (2), aplastic anaemia (2), hemophilia(2) and Wiskott Aldrich Syndrome (1)] and 2 had >1 risk factors(leukaemia and sepsis; congenital heart disease with streptokinaseinfusion after cardiac catheterization). Six (12%) were idiopathic.None had sinovenous thrombosis.OutcomeThe mean follow-up was 6.6 years (1.8-12.4 years). Nine (18%)died, with 5 having ischemic stroke and 4 with hemorrhagic stroke.44% had neurological deficit, including mental retardation (11),epilepsy (9) and hemiplegia (14). Five had recurrent stroke.Decreased consciousness (p=0.004), hematological cause (p=0.04)and hemorrhagic transformation of ischaemic stroke (p=0.01) wereassociated with high mortality. Of the 41 survived, the onlysignificant risk factor for long-term neurological deficit was seizureat initial presentation (p=0.04).ConclusionThe incidence of childhood stroke from our series is 1.7 per100,000 children per year. The majority had thrombo-embolicstroke. The majority who survived had neurological sequelae.Outcome of Children with First Febrile Seizure —A Local Cohort Study of 565 CasesB. Chung, L. Wat, V. C. N. WongDepartment of Paediatrics and Adolescent Medicine, TheUniversity of Hong Kong, Hong KongObjectiveTo investigate the clinical profile and outcome of children admittedfor first febrile seizure (FS) in Hong Kong.MethodsA retrospective study was performed for all children admitted toQueen Mary Hospital with first episode of FS for during a 5 yearsperiod (March 1998 - March 2003) was conducted. FS is definedas “an event in a neurologically healthy infant or child aged 6months to 5 years, associated with fever >38ΟC but withoutevidence of intracranial infection or a defined cause and with nohistory of prior afebrile convulsion” (1). Children with pre-existingdevelopmental delay or underlying neurological disorders wereexcluded.ResultsOf 1113 children admitted during this period with ICD-9 codingof 780.31 for FS, only 565 children were admitted for the firstFS. This First FS database consisted of 565 children (boys : girls =1.4:1). The mean age of onset was 2.1 +/- 1.1 years. Eighty fourpercent (474/565) was simple FS and 16% (91/565) was complexFS. Family history of FS and afebrile seizures were present in17.5% and 2.7% respectively.The commonest infection is upper respiratory tract infection(75%), followed by gastroenteritis (6.3%), lower respiratory tractinfection (4.8%), roseola infantum (3.4%), urinary tract infection(1.4%) and clinical sepsis (1%). The isolated organisms includedinfluenza A (11.8%), adenovirus (4.8%), parainfluenza (4.3%),Respiratory Syncytial Virus (2.7%), influenza B (2.1%) [all fromnasopharyngeal aspirate], Rotavirus (1.4%) and salmonella (1.4%)[from stool]. There was no significant difference between age ofonset, sex, family history of FS, types of infection or causativeorganisms with presentation as simple or complex FS.The mean follow-up period was 2.33 +/- 1.69 years. Altogether103 children had recurrence of FS - with 72% (74/103) having 1recurrence, 17.5% (18/103) with 2 and 10.5% (11/103) with morethan 2 recurrences. The overall recurrence rate was 12.7% by 1year, 18.7% by 2 years and 20.5% by 3 years.Early age of onset [p=0.04; OR = 1.9 (95% C.I. = 1.23-2.95)],family history of FS [p=0.04; OR = 1.8 (95% C.I. = 1.07-3.09)]and complex FS [p=0.005; OR = 1.85 (95% C.I. = 1.02-3.27)]were statistically significant risk factors for recurrence. Only 2children (0.4%) developed afebrile convulsion during follow-up.ConclusionThe estimated incidence of first FS in our local children is 0.3%.The overall recurrence rate for FS was 20%. Risk factors ofrecurrence were similar when compared with Caucasians. Type ofinfections and causative organisms were not important determiningfactors for recurrence from our study.Reference(1) Consensus Development Panel. Febrile seizures: long termmanagement of children with fever-associated seizures. Paediatrics1980;66:1009-12.Selective Doral Rhizotomy in Children with SpasticCerebral PalsyS. C. Kwok, K. Y. Yam, T. S. FongDepartment of Neurosurgery, Tuen Mun Hospital, Hong KongBackgroundSpasticity in children with cerebral palsy has many adverse effectson patient’s normal daily function. Selective dorsal rhizotomy(SDR) is one of the many effective surgical options in managingspasticity. SDR has been performed in Tuen Mun Hospital since1996. Modifications on patient selection and surgical techniquecontinue to be revised every year. We present our latest 2-yearexperience in managing spastic cerebral palsy children with SDR.Method11 patients have undergone SDR between the period of August2001 to August 2003. The extend of dorsal root to be excised wereaffected by pre-operative motor assessment, intra-operative motorand EMG assessment. Range of passive moment, ModifiedAsthworth Score, Gross Motor Function Measure and Gaitpattern were recorded before and after operation. Period of followup included 3 and 12 months. Data during the follow up periodwere then compared.F 4F 5

Hong Kong childhood stroke registry (HKCSR) - a study of 50 cases (1991-2001)

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Hong Kong childhood stroke registry (HKCSR) - a study of 50 cases (1991-2001)

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