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Headache as a risk factor for neurovascular events in pediatric brain tumor patients
Sarah M Kranick1, Cynthia J Campen, Scott E Kasner
1Department of Neurology, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA. sarah.kranick@nih.gov
Insights
Severe recurrent headaches may predict stroke in pediatric brain tumor survivors treated with radiation. This finding aids in monitoring survivors and preventing neurovascular events.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Neurology
Background:
- Pediatric brain tumors are a significant health concern.
- Cranial radiation therapy is a common treatment for pediatric brain tumors.
- Neurovascular events, such as stroke, are potential long-term complications in these survivors.
Purpose of the Study:
- To investigate if severe recurrent headaches are a risk factor for neurovascular events in children treated with radiation for brain tumors.
Main Methods:
- Retrospective cohort study of 265 pediatric brain tumor patients (0-21 years) treated between 1993-2002.
- Severe recurrent headache defined as appearing on 2+ visits, excluding headaches from tumor progression, shunt issues, or infection.
- Medical records were reviewed for stroke or transient ischemic attack (TIA) events.
Main Results:
- 19% of patients with severe recurrent headaches experienced stroke or TIA, compared to 3% without headaches (HR 5.3, p=0.003).
- This association remained significant after adjusting for multiple variables.
- Median time to first neurovascular event was 4.9 years.
Conclusions:
- Severe recurrent headache is a significant risk factor for cerebral ischemia in pediatric brain tumor survivors post-radiation.
- This highlights the need for vigilant monitoring of survivors for neurovascular complications.
- Identifying this risk factor can help target primary stroke prevention strategies in this vulnerable population.
Objective:
To determine whether severe recurrent headache is a risk factor for neurovascular events in children who received radiation for brain tumors.
Methods:
This is a retrospective cohort study of children with brain tumors who received cranial irradiation at a large tertiary care center, aged 0-21 years at diagnosis, with initial treatment between January 1, 1993 and December 31, 2002, and 2 or more follow-up visits. Patients were considered to have severe recurrent headache if this appeared as a complaint on 2 or more visits. Headaches attributed to tumor progression, shunt malfunction, or infection, or appearing at the end of life, were excluded. Medical records were reviewed for events of stroke or TIA.
Results:
Of 265 subjects followed for a median of 6.0 years (interquartile range 1.7-9.2 years), stroke or TIA occurred in 7/37 (19%) with severe headaches compared to 6/228 (3%) without these symptoms (hazard ratio 5.3, 95% confidence interval 1.8-15.9, p = 0.003). Adjusting for multiple variables did not remove the significance of this risk. Median time to first neurovascular event for the entire cohort was 4.9 years (interquartile range 1.7-5.5 years).
Conclusions:
Severe recurrent headache appears to be a risk factor or predictor for subsequent cerebral ischemia in pediatric brain tumor survivors treated with radiation. This finding has clinical implications for both monitoring survivors and targeting a specific population for primary stroke prevention.
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