Etiological Profile of Acute Onset Hemiparesis in Children Admitted at a Tertiary Care Teaching Hospital of Northern India

Abstract

Introduction: Acute hemiparesis, weakness of either half of the body is a common nonspecific neurological response of the central nervous system to a varying of infective/non-infective aetiologies noted among admitted children. There is a paucity of data on etiologies of this condition, from this part of the Indian subcontinent, so this study was planned to describe the etiological profile of hemiparesis in children. Method: This prospective observational study was done from September 2017 to August 2018 at a tertiary care teaching hospital in northern India. Consecutive children of age 2 months to 14 years, admitted with acute onset hemiparesis or developed hemiparesis during hospital stay were enrolled in the study. Data was collected in a predesigned proforma after obtaining consent. Results: 65 children (57% male) who were admitted with hemiparesis, were enrolled. The mean age at presentation was 5.7 ± 3.5 years. Central nervous system infection (CNS) was the most common cause (69%) followed by pediatric stroke (19%). Intracranial space-occupying lesions (SOL), cerebral palsy, and acute disseminated meningoencephalitis (ADEM) were the other important causes of hemiparesis. Among CNS infections, acute encephalitis was found in 43% and tuberculous meningitis in 26% of patients. Japanese encephalitis 9.2%, inflammatory granuloma & abscess (5%), chikungunya (1.5%) and rickettsial infections (1.5%) were other CNS infections identified. In 12 cases of pediatric stroke, 9 were ischemic infarct and the rest were hemorrhagic. Among ischemic infarction 3 were with the prothrombotic state each 1 case of protein C, S & antithrombin III deficiency. 3 children were comorbid with heart diseases (2 cases of valvular heart disease with infective endocarditis & one case of tetralogy of Fallot). Conclusion: This study shows that, in Uttar Pradesh, India, CNS infection and pediatric stroke (non-infective) are the most common cause of acute onset hemiparesis in children.

Keywords

• infectious etiology
• pediatric stroke
• hemiplegia
• northern india