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Lack of progressive arteriopathy and stroke recurrence among children with cryptogenic stroke

Stephane Darteyre1, Stephane Chabrier, Emilie Presles

  • 1Neuropédiatrie, CHU Montpellier, Hôpital Gui de Chauliac, Montpellier, France. stefdart@gmail.com

Neurology
|December 1, 2012
PubMed

Insights

Cryptogenic arterial ischemic stroke (AIS) in children, unlike symptomatic AIS, showed no recurrence with aspirin treatment. These children also experienced better long-term neurologic outcomes.

Area of Science:

  • Pediatric Neurology
  • Vascular Neurology
  • Stroke Medicine

Background:

  • Arterial ischemic stroke (AIS) in children can be challenging to classify, with cryptogenic (unknown cause) and symptomatic (known cause) categories.
  • Understanding the distinct outcomes and characteristics of these pediatric AIS subtypes is crucial for effective management and treatment strategies.

Purpose of the Study:

  • To test the hypothesis that cryptogenic pediatric AIS presents better outcomes than symptomatic AIS.
  • To compare the clinical and radiologic characteristics of cryptogenic versus symptomatic AIS in children.

Main Methods:

  • A retrospective cohort study of 63 pediatric AIS inpatients (aged 0.25-16 years) between 1994-2007.
  • Patients were categorized as cryptogenic (C) or symptomatic (S) AIS based on established cause.
  • Outcomes were assessed by stroke recurrence rate and neurologic impairment score (NIS), with univariate analysis for comparisons.

Main Results:

  • Cryptogenic AIS occurred in 44% of patients; symptomatic AIS in 56%.
  • Group C demonstrated no stroke recurrence with aspirin (0% vs. 30.3% in S), a higher rate of nonprogressive arteriopathies (p=0.02), unilateral infarcts (p=0.01), and M1 segment stenosis (p=0.02).
  • Cryptogenic AIS patients had better stroke outcomes (mean NIS 2.7 vs. 4.2; p=0.04).

Conclusions:

  • Childhood cryptogenic AIS represents a distinct clinical and radiologic entity with potentially uniform pathophysiologic mechanisms.
  • Early and sustained aspirin treatment appears to prevent recurrence in cryptogenic AIS cases.
Abstract

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