Related Experiment Videos
Chickenpox and stroke in childhood: a study of frequency and causation
R Askalan1, S Laughlin, S Mayank
1Hospital for Sick Children and the University of Toronto, Toronto, Canada.
Insights
Varicella infection is a significant risk factor for childhood arterial ischemic stroke (AIS). This study found a threefold increase in varicella preceding AIS, with nearly a third of cases linked to the infection.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Vascular Neurology
Background:
- Arterial ischemic stroke (AIS) in children is a serious neurological event.
- The potential link between viral infections and AIS requires further investigation.
- Varicella (chickenpox) is a common childhood illness with potential systemic complications.
Purpose of the Study:
- To investigate if varicella infection is a causal factor for AIS in pediatric patients.
- To compare the incidence of varicella in children with AIS versus the healthy population.
- To characterize the clinical and radiographic features of varicella-associated AIS.
Main Methods:
- A prospective cohort study involving children aged 6 months to 10 years with AIS.
- Assessment of varicella infection within 12 months prior to AIS diagnosis.
- Comparison with healthy pediatric populations and a literature review of varicella-associated AIS cases.
Main Results:
- 31% of children with AIS had a preceding varicella infection, compared to 9% in the healthy population.
- Varicella-associated AIS cases showed higher rates of basal ganglia infarcts, abnormal cerebral vascular imaging, and recurrent events.
- Literature analysis corroborated these findings, indicating characteristic features of varicella-related AIS.
Conclusions:
- Varicella infection is a significant risk factor for AIS in young children.
- Varicella-associated AIS represents a substantial proportion (nearly one-third) of childhood AIS cases.
- Varicella-associated AIS is associated with an increased risk of recurrent ischemic events.
Background And Purpose:
The purpose of this study was to determine whether infection with varicella is causal for arterial ischemic stroke (AIS) in children.
Methods:
First, a prospective cohort study was conducted in young children (aged 6 months to 10 years) with AIS at 2 institutions (cohort study). The presence of varicella infection <12 months before AIS was determined and compared with the published frequency of varicella infection in the healthy pediatric population. The clinical and radiographic features of AIS were compared between the varicella and nonvaricella study cohorts. Second, a literature search of varicella-associated AIS was conducted, and the clinical and radiographic features were compared with the study nonvaricella cohort.
Results:
In the cohort study, 22 (31%) of 70 consecutive children with AIS had a varicella infection in the preceding year compared with 9% in the healthy population. Children in the varicella cohort were more likely to have basal ganglia infarcts (P<0.001), abnormal cerebral vascular imaging (P<0.05), and recurrent AIS or transient ischemic attacks (P<0.05) than those in the nonvaricella cohort. The pooled literature analysis of 51 cases of varicella-associated AIS showed similar findings to the varicella cohort.
Conclusion:
In young children with AIS, there is a 3-fold increase in preceding varicella infection compared with published population rates, and varicella-associated AIS accounts for nearly one third of childhood AIS. Varicella-associated AIS has characteristic features, including a 2-fold increase in recurrent AIS and transient ischemic attacks. Varicella is an important risk factor for childhood AIS.