A bstract Introduction: Pediatric ischemic stroke, though rare, represents a significant cause of long-term neurological morbidity and mortality. Etiological profiles differ markedly from adults and are often linked to infections, arteriopathies, and prothrombotic states, especially in low-resource settings. Objectives: To describe the clinical presentation and etiological spectrum of pediatric ischemic stroke cases admitted to a tertiary care hospital in South India. Materials and Methods: A retrospective analysis was conducted on 30 children aged 1 month to 18 years diagnosed with ischemic stroke between April 2019 and April 2025. Clinical features, imaging findings, and etiology were analyzed. Etiological classification was based on the Childhood AIS Standardized Classification and Diagnostic Evaluation system. Stroke severity was assessed using the Pediatric National Institute of Health Stroke Scale. Results: The mean age of presentation was 7.1 ± 5.1 years, with a male predominance (63.3%). Hemiparesis was the most common presenting symptom (93.3%), followed by seizures (33.3%) and facial nerve palsy (30%). Magnetic resonance imaging confirmed anterior circulation involvement in 96.6% of cases, most commonly affecting the middle cerebral artery (73.3%). The most common etiology was post-infectious arteriopathy (33.3%; e.g., tuberculosis, varicella, and multisystem inflammatory syndrome in children). Other etiologies included metabolic/prothrombotic disorders (23.3%), bilateral arteriopathies (13.3%), cardioembolic causes (3.3%), and multifactorial/undetermined (26.6%). The majority of cases (80%) had moderate stroke severity at presentation. Conclusion: Infections, mainly tuberculosis, emerged as the leading cause. Anterior circulation stroke was seen in the majority of cases, with hemiparesis being the predominant symptom. A high index of suspicion, timely neuroimaging, and comprehensive etiological work-up are essential for early diagnosis and prevention of long-term sequelae.
Shilpa et al. (Fri,) studied this question.