Objective: Migraine, a typically benign disorder, is the most common stroke mimic in children presenting with brain attacks. We aimed to identify clinical features which discriminate childhood arterial ischaemic stroke (AIS) from migraine.
Methods: Fifty-five consecutive children with AIS, presenting to a tertiary pediatric emergency department (ED), prospectively/retrospectively recruited from 2003-2010, were compared to 84 children with migraine, prospectively recruited from 2009-2010.
Results: Health professional referral, (odds ratio (OR), 5.71, 95% confidence intervals 2.54-12.81), ambulance transport (OR 2.95, 1.45-5.97), high triage category assignment (OR 2.41, 1.06-5.49), sudden onset (OR 2.74, 1.18-6.39), symptoms of focal weakness (OR 6.96, 3.24-14.93), seizures (OR 7.44, 1.99-27.81), speech disturbance (OR 3.06, 1.48-6.32), and ataxia (OR 4.88, 1.63-14.65) were significantly associated with increased odds of AIS diagnosis. Signs of face (OR 155.37, 20.03-1205.33), arm (OR 15.58, 6.41-37.84), or leg weakness (OR 15.40, 5.75-41.27), inability to walk (OR 14.18, 3.07-65.41), dysarthria (OR 47.21, 6.07-367.13), dysphasia (OR 12.76, 1.52-106.97) and altered consciousness (OR 2.45, 1.03-5.85) were also significantly associated with increased odds of AIS diagnosis, In contrast, vomiting (OR 0.23, 0.10-0.53), visual symptoms (OR 0.24, 0.10-0.57), other symptoms (OR 0.06, 0.01-0.48) and absence of neurological signs on ED physician assessment (OR 0.05, 0.01-0.17) were associated with decreased odds of AIS diagnosis.
Conclusion: Differing presenting symptoms and signs allow discrimination of childhood AIS from migraine. These findings can inform decisions about urgency and type of diagnostic neuroimaging in the ED for children presenting with brain attack symptoms.