Divergent Phenotypes and Persistent Disability: A Comparative Cohort Study of Arterial Ischaemic and Haemorrhagic Stroke in Chinese Paediatric Patients

dongyanqing; chunmei yao; yaxian deng; Jingyuan song; Manman Niu; Xingmeng Li; yajie Wang

doi:10.18282/po4894

dongyanqing Department of Pediatrics, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
chunmei yao Department of Pediatrics, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
yaxian deng Department of Pediatrics, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Jingyuan song Department of Pediatrics, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Manman Niu Department of Pediatrics, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Xingmeng Li Department of Pediatrics, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
yajie Wang ^* Department of Pediatrics, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China

Article ID: 4894

Abstract

Background: Paediatric stroke poses a significant clinical challenge with lifelong disability risks. However, comparative analyses delineating subtype-specific manifestations and outcomes between arterial ischemic stroke (AIS) and haemorrhagic stroke (HS) are lacking.

Objective: To characterize and compare the AIS and HS subtypes in a paediatric cohort, focusing on clinical presentation, aetiology, lesion distribution, and outcomes.

Methods: This retrospective cohort study included consecutive paediatric patients (1 month-18 years) with first-ever AIS or HS admitted to Beijing Tiantan Hospital between June 2019 and May 2024. Cases were identified through structured electronic medical record review using standardized diagnostic criteria.

Results: The cohort comprised 72 paediatric stroke cases (42 AIS, 30 HS) with comparable age distributions (median 8.0 vs 8.5 years) but distinct clinical profiles. While AIS patients predominantly presented with focal deficits (73.8% hemiparesis vs 30.0% in HS), HS cases more frequently exhibited diffuse symptoms, including headache (56.7% vs 11.9%) and nausea/vomiting (36.7% vs 4.8%). Etiological evaluation revealed striking differences: arteriopathies (particularly moyamoya disease and vasculitis) were dominant in AIS, whereas structural vascular anomalies (arteriovenous malformations [AVMs] and cavernomas) were characteristic of HS. At the 12-month follow-up, persistent neurological sequelae were common in both groups (AIS 67.6%, HS 64.3%), though disability patterns diverged; AIS survivors demonstrated predominantly motor deficits (56.8% vs 28.6%) while cognitive impairment was more prevalent in HS (21.4% vs 13.5%). Mortality rates remained low (AIS 2.7%, HS 7.1%), with recurrence observed exclusively in AIS cases (5.4%).

Conclusion: Acute paediatric AIS and HS exhibit distinct clinical phenotypes—focal neurological deficits are predominant in AIS versus diffuse symptoms (headache/nausea) in HS, enabling early syndromic differentiation. Despite treatment, persistent neurological morbidity affects >64% of survivors, with subtype-specific disability patterns: AIS is primarily associated with motor impairments, while HS demonstrates greater cognitive sequelae. The low mortality (<7.1%) and recurrence rates reflect advancements in care, yet the enduring disability burden underscores the necessity for subtype-tailored rehabilitation and systematic long-term surveillance.