Risk factors for arterial ischemic stroke in childhood
Fenella J Kirkham1, Alexandra M Hogan
1Neurosciences Unit, Institute of Child Health, University College London, and Southampton University Hospitals National Hospital Service Trust, UK. F.Kirkham@ich.ucl.ac.uk
Insights
Pediatric stroke, affecting boys and African Americans, causes significant disability. Identifying underlying causes and risk factors is crucial for managing this condition in children.
Area of Science:
- Neurology
- Pediatrics
- Vascular Medicine
Background:
- Pediatric stroke affects 13/100,000 children, with higher incidence in boys and African Americans.
- Associated morbidities include cognitive, psychiatric, and motor disabilities.
- Hemorrhagic and ischemic strokes are equally common, with varied underlying conditions.
Purpose of the Study:
- To summarize the epidemiology, risk factors, and underlying pathologies of pediatric stroke.
- To highlight the association between stroke and various medical conditions.
- To discuss potential etiological roles of genetic factors, trauma, infections, and environmental influences.
Main Methods:
- Review of existing literature on pediatric stroke.
- Analysis of epidemiological data and risk factors.
- Categorization of underlying conditions and vascular pathologies.
Main Results:
- Sickle cell disease, cardiac, chromosomal, and neurocutaneous abnormalities are common underlying conditions.
- Up to 50% of ischemic stroke cases lack a prior diagnosis.
- Cerebrovascular disease is prevalent in arterial distribution infarcts, including dissection and moyamoya.
- Hypertension, hypoxia, and poor nutrition are identified as intermediate risk factors.
Conclusions:
- Pediatric stroke has multifactorial causes, including genetic predisposition and environmental factors.
- Cerebrovascular disease is a significant finding in pediatric stroke patients.
- Further research, including large cohorts and trials, is needed for evidence-based management strategies.
Abstract:
Stroke affects up to 13 of 100,000 children, is more common in boys and African Americans, and is associated with considerable cognitive and psychiatric morbidity, as well as motor disability. Around half are hemorrhagic and half are ischemic. Underlying conditions include sickle cell disease, cardiac abnormalities, chromosomal abnormalities (eg, Down syndrome), and neurocutaneous conditions (eg, neurofibromatosis), but up to half the patients with ischemic stroke have no previously diagnosed condition. Although there is almost certainly an important genetic component to stroke risk, head trauma, infections, drugs and radiation appear to play an etiological role in some patients. The majority of the patients with infarction in an arterial distribution have associated cerebrovascular disease. Vascular pathologies include carotid or vertebrobasilar dissection, intracranial vasculopathy affecting the middle and anterior cerebral arteries, which is often transient, and moyamoya. Intermediate risk factors may include hypertension, hypoxia, and poor nutrition leading, for example, to iron deficiency and hyperhomocysteinemia. Some chronic conditions may directly influence the child's behavior and stroke recurrence risk, although large cohorts and randomized controlled trials will be needed before strategies for modification can be evidence-based.
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