United Kingdom

**Abstract authors:**

Julie Meadows¹, Edward Smith¹, Laura Lehman²

¹Boston Children&#39;s Hospital, ²Attending

**Abstract body:**

Introduction: Children with moyamoya and their parents experience significant stress around the time of diagnosis. There are not many studies that examine the extent of the symptoms including clinical concerns for anxiety and depression around time of diagnosis. Hypothesis: Children with moyamoya and their parents will have higher rates of anxiety and depression on standardized questionnaires than the general population. Methods: We enrolled parents of children with moyamoya as well as the child if child was 6 years of age or older prior to revascularization surgery. At time of enrollment parents and child filled out standardized questionnaires on symptom of anxiety and depression. Parents filled out Beck&#39;s Depression Inventory (BDI) and Beck&#39;s Anxiety Inventory (BAI). Children filled out the Behavioral Assessment System for Children 3rd edition (BASC-3). Results: A total of 22 children with moyamoya enrolled in our study, some children were less than 6 years old so we did not collect emotional outcomes on them. Children&#39;s age ranged from 13 months to 18 years old with 14 females (63%). In our cohort of children with moyamoya 12 children, 17 mothers, and 12 fathers filled out questionnaires. Four fathers (33%) and 4 mothers (24%) had clinical concern for depression. We did not have any mothers or fathers with clinical concern for anxiety. However, 4 children (33%) had clinical concern for anxiety and 3 children (25%) had clinical concern for depression. Conclusion: Compared to the general population children with moyamoya have higher rates of depression and anxiety while their parents have higher rates of depression. Further research is needed to determine if symptoms improve post-revascularization surgery.

IPSO 2023

Depression and Anxiety in Children and their Parents Following Diagnosis of Moyamoya

### Welcome to CogSci Conference 2025!

The 47th Annual Meeting of the Cognitive Science Society was a hybrid meeting held in San Francisco. 

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#### About

The Cognitive Science Society brings together researchers from around the world who hold a common goal: understanding the nature of the human mind. The mission of the Society is to promote Cognitive Science as a discipline, and to foster scientific interchange among researchers in various areas of study, including Artificial Intelligence, Linguistics, Anthropology, Psychology, Neuroscience, Philosophy, and Education.

The Society is a non-profit professional organization and its activities include sponsoring an annual conference and publishing the journals Cognitive Science and TopiCS.

#### Our History 

* **Society Creation**<br>
The Society was incorporated as a 501(c)(3) non-profit professional organization in Massachusetts in 1979. The organizing committee included Roger Schank, Allan Collins, Donald Norman, and a number of other scholars from psychology, linguistics, computer science, and philosophy. 
<br><br>
* **Conference Creation**<br>
The first conference on cognitive science was held at La Jolla, California in August, 1979, and has occurred annually since then. The proceedings of each conference are published, and those from most years are available through Lawrence Erlbaum Associates, Inc. The annual proceedings of the Cognitive Science Conference represent a major source of information on new work and new ideas in the scientific study of thinking. In 1990, the Society, with help from an anonymous donor, established the David Marr Prize for the best student paper at each annual meeting.
<br><br>
* **Journal Creation**<br>
The Journal, Cognitive Science, began publication in 1976, and is now published by Wiley-Blackwell. The Executive Editor is currently Richard P. Cooper of Birkbeck, University of London, and there are 18 Associate Editors and a 30-member editorial board. It serves as the premier outlet for research reports that intersect two or more disciplines. Copyrights for articles published in the journal are held by the Society. The Governing Board of the Cognitive Science Society voted in late 2006 to found a new journal, Topics in Cognitive Science (topiCS). The Editor in Chief is Wayne Gray, Cognitive Science Department, Rensselaer Polytechnic Institute. The journal seeks to fill a niche not occupied by Cognitive Science Journal or other cognitive science journals. Membership in the Society includes a subscription to Cognitive Science and TopiCS. Copyrights for articles published in the journal are held by the Society.
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#### Code of Conduct

By attending the CogSci 2025 Conference, you are required to adhere to the society’s **[Code of Conduct](https://drive.google.com/file/d/1ChPuihLy6jE_BWqfO7J2KKgX35JW2zsM/view?usp=sharing)**.
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CogSci 2025

The 47th Annual Meeting of the Cognitive Science Society presents the latest research across cognitive science and highlights the theme of Cognition in Context.

**Abstract authors:**

Julie Meadows¹, Edward Smith¹, Laura Lehman²

¹Boston Children's Hospital, ²Attending

**Abstract body:**

Introduction: Children with moyamoya and their parents experience significant stress around the time of diagnosis. There are not many studies that examine the extent of the symptoms including clinical concerns for anxiety and depression around time of diagnosis. Hypothesis: Children with moyamoya and their parents will have higher rates of anxiety and depression on standardized questionnaires than the general population. Methods: We enrolled parents of children with moyamoya as well as the child if child was 6 years of age or older prior to revascularization surgery. At time of enrollment parents and child filled out standardized questionnaires on symptom of anxiety and depression. Parents filled out Beck's Depression Inventory (BDI) and Beck's Anxiety Inventory (BAI). Children filled out the Behavioral Assessment System for Children 3rd edition (BASC-3). Results: A total of 22 children with moyamoya enrolled in our study, some children were less than 6 years old so we did not collect emotional outcomes on them. Children's age ranged from 13 months to 18 years old with 14 females (63%). In our cohort of children with moyamoya 12 children, 17 mothers, and 12 fathers filled out questionnaires. Four fathers (33%) and 4 mothers (24%) had clinical concern for depression. We did not have any mothers or fathers with clinical concern for anxiety. However, 4 children (33%) had clinical concern for anxiety and 3 children (25%) had clinical concern for depression. Conclusion: Compared to the general population children with moyamoya have higher rates of depression and anxiety while their parents have higher rates of depression. Further research is needed to determine if symptoms improve post-revascularization surgery.

poster

Dear IPSO Virtual Conference Attendees:

Welcome to the IPSO 2023 Virtual Conference. We are delighted to bring together experts from multiple disciplines and six continents to provide a diverse perspective on pediatric cerebrovascular disease.

A few quick words about what to expect. Two important goals of this conference are to (1) foster a sense of community and (2) identify global priorities for our field. We encourage you to express your thoughts live in through the chat function to provide a global perspective on all topics. Please introduce yourself in the chat, so everyone knows where you are attending from.

We are excited to announce IPSO is able to offer 9.5 CME units for the virtual conference. If you would like to claim CME credits, please email membership@internationalpediatricstroke.org. 

We want to hear from you! Planning for IPSO 2024 Congress on March 22nd-24th in Toronto, Canada, will commence as soon as the Virtual Conference ends. Let us know your priorities through the live chat function, via email, or by submitting a symposium idea. Based on your input, the Scientific Program Committee will select the topics that we will address in greater depth when we meet again in the spring.

We hope you find the Virtual Conference both interesting and educational, and hope to see you in person in Toronto, or at another IPSO meeting in the future.

Warm regards,

Heather Fullerton, IPSO President<br>
Maja Steinlin, IPSO Vice-President<br>
Lori Jordan, IPSO Secretary & Treasurer<br>
Noma Dlamini, IPSO Scientific Program Committee Chair<br>


The International Pediatric Stroke Organization (IPSO) 2023 Virtual Conference is April 28-29th, 2023. The mission of the virtual conference is to unify the global community of professionals engaged in research and clinical care for children with cerebrovascular diseases, and chart a path forward for multinational, multidisciplinary efforts. Similar to the IPSO 2021 Virtual Conference, IPSO has partnered with Underline to host this virtual conference. 

The 2023 IPSO Virtual Conference will offer:

* A highly interactive format: brief recorded talks followed by live panel discussions with audience participation through a chat function and live audience surveys
* Optional break-out groups for IPSO committees, working groups, councils
* Poster sessions available on-demand throughout the conference with a chat function for the audience to comment for ask questions of the presenters

Disclaimer: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of UCSF and the International Pediatric Stroke Organization (IPSO) and Hospital for Sick Children, and Vanderbilt University Medical Center. UCSF is accredited by the ACCME to provide continuing medical education for physicians.

 UCSF designates this live activity for a maximum of 9.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Contact membership@internationalpediatricstroke.org if you would like to claim CME for the IPSO 2023 Virtual Conference. 

**About**<br>
Founded in February, 2019, we are an organization of health professionals, scientists and patient advocates who care about stroke and other cerebrovascular diseases in childhood. We developed out of our original collaborative network, the International Pediatric Stroke Study (IPSS), and now aim to broaden the scope of our mission beyond research.

* Our mission is to improve the lives of children worldwide with cerebrovascular disease through research, education, clinical care and advocacy.

* Our Vision is a world in which international, multidisciplinary collaborations advance the understanding, care, and outcomes of childhood cerebrovascular disease.






To access IPSO 2023 site, please register [here](https://internationalpediatricstroke.org/2023-virtual-conference/registration/). 

The mission of the International Pediatric Stroke Organization (IPSO) 2023 Virtual Conference is to unify the global community of professionals engaged in research and clinical care for children with cerebrovascular diseases, and chart a path forward for multinational, multidisciplinary efforts. 



**Abstract authors:**

Kathryn (Casey) Nesbit¹, Bryce Yale², Laura Hess³, Micah Mar², Alejandra Roque⁴, Dana Jacobs², Janice Brown³, Jordan Ng³, Reilly Todd³, Alyssa Vo³

¹Assistant Professor, ²UCSF/SFSU Graduate Program in Physical Therapy, ³Dominican University of California, ⁴NAPA Center, Inc

**Abstract body:**

Pediatric stroke has a significant impact on children and families. Outcome measures are essential to guide clinical management and inform research priorities, yet these instruments are highly varied in scope and application. Because pediatric stroke care and research is evolving, there is a need for a current review of pediatric stroke outcome measures. The purpose of this study was to systematically review the current literature for pediatric outcome measures, describe the studies using pediatric outcome measures, and describe the outcome measure characteristics. From an initial search of 1625 articles with duplicates removed, 116 articles met inclusion criteria. In those 116 articles, 95 distinct outcome measures were identified. Our review noted the most used outcome measures focused on deficits of the child whereas there was a paucity of outcomes used that included patient and family perspectives, recovery in natural contexts (e.g., home, school, community), and inadequate representation executive function and quality of life. We also found a lack of reliable and valid outcomes for the pediatric hemorrhagic stroke population, and a limited number of outcomes that measure recovery over time. The findings in this systematic review support recommendations for future development and use of pediatric stroke outcome measures, particularly for pediatric hemorrhagic stroke, that better capture the impacts to child and family life and contextually meaningful aspects of recovery over time.

Outcome Measures in Pediatric Stroke: A Systematic Review

**Abstract authors:**

Claire Champigny¹, Samantha Feldman¹, Nataly Beribisky², Mary Desrocher², Tamiko Isaacs², Pradeep Krishnan¹, Georges Monette², Nomazulu Dlamini¹, Peter Dirks¹, Robyn Westmacott¹

¹the Hospital for Sick Children, ²York University

**Abstract body:**

Objective: This prospective clinical study examined the impact of eight predictors on neurocognitive outcomes following pediatric stroke across a range of domains (e.g., processing speed, working memory, executive functions). Predictors included: age at stroke, stroke type (arterial ischemic vs. hemorrhagic), lesion size relative to total brain volume, lesion location and structures involved, time since stroke, neurologic severity, presence of seizure disorder post-stroke, and socioeconomic status (i.e., household income). Method: Youth with a history of stroke (n=92) underwent neuropsychological testing. Their caregivers completed a standardized parent report. Hospital records provided medical history. Spline regressions, likelihood ratio tests, one-way analysis of variance, Welch's t-tests, and simple linear regressions examined associations between predictors and outcome measures. Results: Larger lesions and lower household income were significantly associated with worse neurocognitive outcomes across most domains. Ischemic stroke was associated with worse outcome in attention and executive functions compared to hemorrhagic stroke. Participants with a seizure disorder had more severe executive functioning impairments than participants without seizures. Youth with cortical-subcortical lesions scored lower on a few measures than youth with cortical or subcortical lesions. Neurologic severity predicted scores on few measures. No significant differences were found based on age at stroke, time since stroke, lesion laterality, or supra- versus infratentorial lesion. Conclusions: Lesion size and household income predict neurocognitive outcome following pediatric stroke. Findings should inform clinical practice through enhanced appraisals of prognosis, tailored psychoeducation for families, and the development of services and interventions aimed at fostering optimal development for youth with stroke.

Lesion size and household income predict neurocognitive outcome following pediatric stroke

**Abstract authors:**

Justine Ledochowski¹, Mahmoud Slim¹, Mary Desrocher², Robyn Westmacott¹, Nomazulu Dlamini¹

¹The Hospital for Sick Children, ²York University

**Abstract body:**

Motor impairments are one of the most common adverse outcomes after pediatric arterial ischemic stroke (AIS) yet knowledge of the relationship with intellectual abilities is limited. We hypothesized that motor functioning in early post-AIS recovery would be associated with intellectual functioning. Participants were 64 children, 34 childhood AIS (Mage= 11.90[2.38]); 30 perinatal AIS (Mage= 8.75[2.22]), from the Children's Stroke Program at SickKids Hospital. Motor functioning was assessed with the Pediatric Stroke Outcome Measure sensorimotor subscale at two timepoints, Time 1: early recovery (childhood: 30 days post-stroke to 1 year; perinatal: 2-5 years of age) and Time 2: closest to neuropsychological testing. Intellectual abilities were measured using the Wechsler Intelligence Scale for Children 4th or 5th edition. Motor functioning at Time 1 was associated with processing speed (r= -.391, p= .036) in the perinatal group and with intellectual functioning (r= -.414, p= .018) verbal abilities (r= -.444, p= .011), working memory (r= .393, p= .026), and processing speed (r= -.351, p= .042) in the childhood group. There were no associations between Time 2 motor functioning and intellectual abilities in the perinatal group, and only with processing speed (r= -.525, p= .002) in the childhood group. When motor functioning was dichotomized (no/mild vs. moderate/severe), at Time 1 children with perinatal AIS and moderate/severe deficit had significantly lower perceptual reasoning (t[28]= 2.15, p= .040) and children in the childhood group with moderate/severe deficit had significantly lower perceptual reasoning (t[32]= 2.35, p= .025) and processing speed (t[32]= 2.14, p= 0.41). No differences were found at Time 2. Associations between motor functioning during early stroke recovery and intellectual abilities may be related to neuroplastic changes post-injury, affecting subsequent development of intellectual abilities through hierarchical maturational processes.

Associations Between Motor Functioning and Intellectual Abilities in Pediatric Arterial Ischemic Stroke

**Abstract authors:**

Nicolas Serratrice¹, Andrea Bartoli¹, Kristof Egervari¹, Anne-Laure Rougemont-Pidoux¹, Eugénie Barras¹, Joël Fluss¹

¹HUG

**Abstract body:**

Introduction: Malignant neonatal arterial ischemic stroke concomitant with large vessel occlusion are rare and potentially life-threatening. Their origin is still controversial and very few cases reported in the literature. Case: The neonate was born full-term following an uneventful pregnancy without obstetrical maneuvers. Mild transient distress was noted at birth. Due to increasing lethargy, hypotonia and possible subtle seizures on day 2 of life, MRI was promptly conducted and showed an extensive left malignant hemispheric infarct with mass effect, left uncal herniation, right MCA infarct as well significant brainstem wallerian degeneration well visible on DWI and T2 sequences. Besides the ischemic lesions, the MRI angiography showed a complete occlusion of the left ICA, due a thrombus extending into the left MCA. Echocardiography demonstrated a PFO, normal anatomical structures, no intracardiac thrombus. The child rapidly deteriorated and was transferred to the NICU for reanimation. Given the very poor prognosis, and after multidisciplinary consensus as well as family approval, withdrawal of care was decided, and comfort measures initiated. The child died in parents' arms on day 3. Prothrombotic work-up was negative. On autopsy, thrombi were identified in the portal vein, the left iliac artery, the left MCA, and the left SCA. Large bilateral cerebral infarcts related mainly to the MCA territories were confirmed. A high grade fetal malperfusion syndrome with multiple thrombi within chorionic vessels was seen on placenta examination. Based on the various findings, it appears very likely that the severely abnormal placenta was the source of multiple thromboembolic stroke. Discussion: This case adds not only evidence of the presumed pathogenesis of perinatal arterial ischemic stroke, but also highlights the potential dramatic outcome of such situation, in particular when persistent occlusion of major neonatal cerebral vessel is still present on early imaging.

Fatal malignant neonatal arterial ischemic stroke with internal carotid occlusion: a pathological and clinic-radiological case study

**Abstract authors:**

Trish Domi¹, Darcy Fehlings², Pradeep Krishnan¹, Mahohar Shroff¹, Matylda Machnowska³, Amanda Robertson¹, Gabrielle deVeber¹, on behalf of the CP-NET Group⁴

¹Hospital for Sick Children, ²Holland Bloorview Rehabilitation Hospital, ³Sunnybrooke Health Sciences Center, ⁴Holland Bloorview Rehabiliation Center

**Abstract body:**

Objective: We sought to determine risk factors for hemiplegic cerebral palsy (HCP) associated with perinatal arterial ischemic stroke (AIS) or periventricular venous infarction (PVI). Methods: We studied children with hemiplegic cerebral palsy (HCP) enrolled at nine rehabilitation centres across Ontario. We compared children with underlying AIS or PVI on clinically acquired brain imaging. In addition, we analyzed prenatal (maternal, prenatal/gestational) and perinatal (obstetrical, neonatal) characteristics collected from birth records and standardized parent interviews. Results: The 144 children with HCP (62% male) included 95 with AIS and 49 with PVI. On multivariate analysis, children with PVI had increased rates of maternal fertility treatment (OR=4.7;95%CI=1.0-28.7;p=0.0379) and decreased rates of neonatal seizures (OR=0.03;95%CI=0.0002-0.255;p=0.0001), systemic blood clots (OR=0.082;95%CI=0.0006-0.795;p=0.0278) and emergency cesarian section (OR=0.3;95%CI=0.093-0.896). Preterm delivery rates were similar for AIS and PVI. Conclusion: We determined novel risk factors differentiating the two most typical forms of focal ischemic brain injury in children with hemiplegic CP. These include fertility treatments, mode of delivery, neonatal seizures and systemic blood clots. These findings provide direction for further research exploring causal pathways of focal brain injury and cerebral palsy.

Risk factors for Hemiplegic Cerebral Palsy due to Arterial Ischemic Stroke or Periventricular Venous Infarction

**Abstract authors:**

Moran Hausman-Kedem¹, Stephanie Libzon¹, Aviva Fattal-Valevski², Gustavo Malinger³, Shlomi Constantini², Nina Kreiden², Jonathan Roth², Liat Ben Sira², Shelly Shiran²

¹Tel Aviv Sourasky Medical Center, ²Dana Children's Hospital, Tel Aviv Sourasky Medical Center, ³Lis Maternity Hospital, Tel Aviv Sourasky Medical Center

**Abstract body:**

OBJECTIVE: to characterize clinical, neuroimaging data and etiology of spontaneous perinatal intracranial hemorrhage (spICH) in non-preterm. METHODS: a prospective, single-center study of 102 consecutive cases with spICH identified in the fetal/neonatal period between 2014-2022. RESULTS: Fifty-nine cases (58%) were diagnosed antenatally (termination of pregnancy-n=22). Intraventricular hemorrhage (IVH) was the most common hemorrhage type (73%), followed by periventricular hemorrhagic venous infarction (PVHI) (54%), parenchymal (13%), subdural (12%) and subpial (10%) hemorrhage. IVH was more commonly diagnosed prenatally (p=0.003), whereas subpial hemorrhage was exclusively diagnosed postnataly (p<0.001). Of the 73 born neonates, those with prenatal diagnosis were less likely to show symptoms in the perinatal period (p=0.005). There was no difference between prenatal versus postnatal cases or between types of hemorrhage in terms of maternal age, parity status, and mode of delivery. Intrauterine growth retardation was associated with parenchymal hemorrhage (p=0.039). Germinal matrix was the most common origin of hemorrhage (48%) and was more common in the prenatal group (65% vs. 28%, p<0.001), followed by choroid plexus (46%), hemorrhagic transformation of venous infarction (8%), bleeding diathesis (3%), vascular malformation (2%) and congenital tumor (1%). A family history of thrombophilia or coagulopathy was associated with subpial hemorrhage (p=0.033), and post-natal IVH (p=0.009). Genetic workup was performed in 42%, yielded a diagnosis in 35% of them, mostly with antenatal bleeding (p=0.003), and was associated with prenatal PVHI (p=0.029). Conclusion: Patterns of hemorrhage, as well as mechanisms, were different between the prenatal and postnatal cases, suggesting different disease mechanisms. Coagulopathy may contribute to spICH presenting in the postnatal period, whereas genetic factors play a major role in prenatal ICH.

Spontaneous perinatal intracranial hemorrhage-clinical, neuro-imaging and etiological correlates

**Abstract authors:**

Meghan Maiani, Alicia Hilderley¹, Catherine Lebel¹, Helen Carlson¹, Adam Kirton¹

¹University of Calgary

**Abstract body:**

Introduction: Perinatal stroke (PS) occurs in 1:1100 births and impairment can affect independence throughout the lifespan. The most common types of PS are arterial ischemic stroke (AIS) and periventricular venous infarction (PVI). Cerebral visual impairment is common after PS but mechanisms remain under-investigated. Understanding the structural development and plasticity of visual pathways will support the advancement of prognostic tools and contribute to validated therapies reducing impairment. Hypothesis: White matter microstructure of the afferent visual pathway will be altered in PS compared with typically developing controls (TDCs), with the greatest differences in children with AIS. Methods: White matter diffusion imaging and tractography were used to isolate optic radiations. Diffusion and T1-weighted anatomical sequences were obtained using a 3T GE MR750w scanner. Probabilistic white matter tractography was completed using anatomically placed regions of interest combined with a constrained spherical deconvolution model.. Mean fractional anisotropy (FA) was extracted for each optic radiation and compared between PVI, AIS and TDCs using ANCOVA, controlled for age. FA was compared between hemispheres using paired t-tests. Results: Ninety-three children aged 6-18 years (N=22 AIS, N=28 PVI) as well as similarly aged TDCs (N=43) were recruited. Both AIS and PVI groups showed lower FA in both the lesioned and non-lesioned hemispheres compared to controls (p<0.001). Between-hemisphere differences in FA were present in the AIS group (p<0.001), but not in PVI (p=0.21). Conclusion: Analysis of white matter in visual pathways shows bihemispheric differences in microstructure between children with different PS types and healthy controls, with the greatest differences observed in the AIS group. Future research will investigate perceptual and ophthalmological outcomes to determine prevalence and severity of visual impairment in children with PS, specifically AIS.

White matter tractography of visual pathways in children with perinatal stroke

**Abstract authors:**

Inna Shchederkina¹, Natalia Bronina¹, Aleksandra Kuznetsova¹, Matvey Livshits¹, Ella Kumirova¹

¹Morozov Children's Clinical Hospital

**Abstract body:**

Risk factors of stroke in oncological diseases are: direct effects of the tumor, infection, coagulopathy, diagnostic and treatment procedures, chemotherapy and radiation therapy, bone marrow transplantation, and hematopoietic factors. Material and methods: The study included children treated at the Morozov Children's Clinical Hospital who had a diagnosis of cancer with cerebrovascular complications from 2018 to 2020. Methods: clinical, anamnestic, laboratory, neuroimaging. Results: For the period 2018-2020, 369 children were included in the Moscow register of cerebrovascular diseases, of which 41 patients (11.1%) had cancer. The average age was 7.5 years, of which 51.2% were boys. Group 1 - patients with brain tumor - 21 patients (51.2%); group 2 - patients with leukemia - 22%, group 3 - patients with extracranial tumor - 26.8%. Arterial ischemic stroke (AIS) was observed in 14 children - 10.4% of all AIS in stroke register, hemorrhagic stroke (HI) in 21 children, which accounted for 11.7%, sinus thrombosis (ST) in 6 patients - 10.7%. In group 1, the distribution was as follows: AIS 38%, HI 47.6%, ST 9.5%. Death was in 8 patients (19,5%), among all deaths due to cerebrovascular disease - 22.8%. In group 1, death was 14.2%, in group 2 - 44%, in group 3 - 9%. Conclusion.Cerebrovascular complications in oncology diseases are not rare. In patients with neurooncology HI predominated. Cerebrovascular complications increased mortality among cancer patients.

Cerebrovascular complications in oncology diseases in children: experience of the Primary Pediatric Stroke Center and pediatric oncological Center of Moscow .

**Abstract authors:**

Débora Sanz¹, María Vazquez¹, Ana Jové¹, Yolanda Ruiz¹, Paula Vazquez¹, Jesús López-Herce¹

¹Hospital Universitario Gregorio Marañon

**Abstract body:**

Background and Aims Paediatric stroke is a rare event, ~2/100.000 children, but it has an important morbidity, being the main cause of acute acquired cerebral injury. Stroke alerts and care pathways have become an integral part of acute paediatric stroke care and their implementation is recommended by several Stroke and Neurology Associations. Methods A prospective, observational study was performed, in our tertiary paediatric institution, from February 2019 to December 2022, since implementation of a multidisciplinary stroke alert system and care pathway in our county and hospital. Demographic, clinical and neuroimaging data was collected and analysed. Results There were 92 stroke alert activations during the study period, but only 27 (29.3%) were true strokes. 19 of them were ischemic (70.4%), 7 haemorrhagic strokes (25.9%) and 1 sinus venous thrombosis (3.7%). Age range for patients who suffered a stroke was 6 months to 15 years old, with a peak incidence in patients older than 10 years, 14 patients (51.9%). 70.4% were males. 17 patients required more than one neuroimaging technique for the diagnosis of stroke, generally cranial computed tomography (CT) followed by magnetic resonance image (MRI). Invasive intracranial pressure monitoring was used in 3 patients. Only 2 patients with ischemic stroke received acute treatment with thrombolysis, and 1 of them received also thrombectomy. 3 patients with haemorrhagic strokes underwent surgery. 4 patients underwent endovascular treatment, 3 of them had a diagnosis of cerebral AVM and 1 had a basilar aneurysm. 2 patients died (7.4%). 19 patients of 25 survivors (76%) suffered sequelae after stroke, most of them hemiparesis 15 (78.9%). Conclusions A stroke was detected in almost a third of stroke alert activations and acute treatment was uncommon in our cohort. The implementation of a multidisciplinary alert system improves diagnosis and treatment of stroke patients.

Stroke diagnosis and characteristics after implementing a multidisciplinary stroke alert system

**Abstract authors:**

Ria Pal¹, Katherine Xiong¹, Sarah Lee¹

¹Stanford University

**Abstract body:**

Introduction Rapid stroke diagnosis via emergent neuroimaging can prevent secondary injury. Pediatric stroke alerts, however, are infrequent, leading to limited opportunities to practice protocols. Pediatric stroke alerts also require urgent collaboration between multiple discrete teams to coordinate imaging, sedation, hyperacute treatments, and other aspects of care. This can result in communication breaks, logistical challenges, and unclear divisions of responsibility. Objective By identifying stakeholder needs across disciplines, we sought to streamline our ED stroke alert process and improve time-to-imaging for children presenting acutely with suspected stroke. Methods We performed a retrospective assessment of stroke alerts in the Stanford pediatric ED from 2016-2021. Root cause analysis was performed using the 5 Whys methodology and fishbone diagram. Surveys were conducted with neurology, emergency medicine, pediatric anesthesia, neuro-IR, and neuroradiology stakeholders regarding potential sources of imaging delays. Staged interventions were implemented between January-June 2022 using Plan-Do-Study-Act cycles. Time-to-imaging was measured for each stroke alert pre- and post-intervention. Results Surveys indicated that key drivers of imaging delays could be categorized as provider protocol familiarity, information and equipment availability, and process and outcome transparency. Interventions were designed to address each key driver (Figure 1). Post-implementation, short-term analysis demonstrated a consistent but as yet-statistically insignificant decrease in mean time-to-imaging for CT (47±31 to 22±13 minutes, p=0.26), MRI without sedation (67±52 to 49±22 minutes, p=0.15), and MRI with sedation (151±42 to 92±7 minutes, p=0.07, Figure 2 ). Conclusions Communication across teams is essential for effective pediatric stroke care. We offer our process improvement experience with adaptable interventions at a large, tertiary-care hospital system.

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