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Investigation of risk factors in children with arterial ischemic stroke
Vijeya Ganesan1, Mara Prengler, Michael A McShane
1Neurosciences Unit, University College London, United Kingdom. v.ganesan@ich.ucl.ac.uk
Insights
Pediatric arterial ischemic stroke risk factors include anemia and MTHFR mutations. While cerebral artery imaging is often abnormal, cardiac and thrombophilia screenings are typically negative in children with stroke.
Area of Science:
- Neurology
- Pediatrics
- Vascular Medicine
Background:
- Childhood arterial ischemic stroke (AIS) is a rare but serious neurological event.
- Identifying risk factors is crucial for prevention and management in pediatric populations.
Purpose of the Study:
- To analyze the known risk factors in children experiencing their first arterial ischemic stroke.
- To evaluate the utility of various diagnostic investigations in this cohort.
Main Methods:
- Retrospective analysis of 212 children with first AIS over 22 years at a tertiary center.
- Review of clinical history, physical examination, cerebral arterial imaging, echocardiography, and thrombophilia screening.
- Statistical analysis to identify significant associations with stroke and arterial abnormalities.
Main Results:
- Cerebral arterial imaging was abnormal in 79% of investigated patients.
- Anemia (40%) and elevated homocysteine or MTHFR mutation (21%) were common.
- Trauma and varicella zoster infection were more frequent in previously healthy children.
- Elevated systolic blood pressure and recent varicella showed significant associations with arterial abnormalities.
Conclusions:
- Clinical evaluation is key for identifying AIS triggers in children.
- Cerebral arterial imaging frequently reveals abnormalities, whereas echocardiography and thrombophilia screening are often unrevealing.
- Further research into specific risk factors like MTHFR mutations and infections is warranted.
Abstract:
We present data on the known risk factors encountered in children presenting with a first arterial ischemic stroke to a single tertiary center over 22 years. Two hundred twelve patients (54% male; median age, 5 years) were identified. One hundred fifteen (54%) were previously healthy. Cerebral arterial imaging was undertaken in 185 patients (87%) and was abnormal in 79%. Of 104 previously healthy patients investigated with echocardiography, only 8 had abnormal studies. Genetic or acquired conditions causing thrombophilia were rare. Forty percent of patients were anemic, and 21% either had elevated total plasma homocysteine or were homozygous for the t-MTHFR mutation. Trauma and previous varicella zoster infection were significantly more common in the previously healthy group. There was a significant association between cerebral arterial abnormalities and systolic blood pressure greater than 90th percentile and a trend for an association with varicella within the previous year. Clinical history and examination usually identify underlying risk factors and precipitating triggers for arterial ischemic stroke in childhood. Cerebral arterial imaging is usually abnormal, but echocardiography and prothrombotic screening are commonly negative.
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