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Published on: April 21, 2017
Workup for Perinatal Stroke Does Not Predict Recurrence
Laura L Lehman1, Jeanette Beaute2, Kush Kapur2
1From the Stroke and Cerebrovascular Center (L.L.L., J.B., A.R.D., M.E.B.-L., H.M., M.J.R., C.C.T.), Departments of Neurology (L.L.L., J.B., K.K., M.E.B.-L., M.J.R.), Psychiatry (M.J.R.), and Radiology (A.R.D., M.J.R.), and Division of Hematology/Oncology (H.M., C.C.T.), Boston Children's Hospital, Harvard Medical School, MA. laura.lehman@childrens.harvard.edu.
Insights
Thrombophilia, arteriopathy, and cardiac issues do not predict recurrent perinatal stroke. Evaluation for these factors is rarely needed in pediatric stroke cases.
Area of Science:
- Neurology
- Pediatrics
- Vascular Medicine
Background:
- Perinatal stroke is the most common stroke type in childhood.
- The roles of thrombophilia, arteriopathy, and cardiac anomalies in perinatal ischemic stroke remain unclear.
- Understanding these risk factors is crucial for managing recurrent stroke.
Purpose of the Study:
- To investigate the association between thrombophilia, arteriopathy, cardiac anomalies, and recurrent stroke in perinatal stroke patients.
- To evaluate the utility of routine thrombophilia testing in this population.
- To inform clinical practice regarding the workup of perinatal stroke.
Main Methods:
- A retrospective review of 215 perinatal stroke patients evaluated at a single center.
- Data collected included demographics, echocardiography, arterial imaging, and thrombophilia testing.
- Statistical analysis using Fisher exact test to assess associations with recurrent stroke.
Main Results:
- Among 215 cases with a median follow-up of 3.17 years, 6 (2.8%) experienced recurrent ischemic events.
- Thrombophilia, arteriopathy, or cardioembolic risk factors were not significantly associated with recurrent stroke.
- A positive family history of thrombosis did not predict abnormal thrombophilia testing.
Conclusions:
- Thrombophilia, arteriopathy, and cardioembolic risk factors are not predictive of recurrent events after perinatal stroke.
- Routine thrombophilia evaluation should be considered only rarely in perinatal stroke cases.
- Further research may clarify specific high-risk subgroups.
Background And Purpose:
Perinatal stroke, including neonatal and presumed perinatal presentation, represents the age in childhood in which stroke occurs most frequently. The roles of thrombophilia, arteriopathy, and cardiac anomalies in perinatal ischemic stroke are currently unclear. We took a uniform approach to perinatal ischemic stroke evaluation to study these risk factors and their association with recurrent stroke.
Methods:
We reviewed records of perinatal stroke patients evaluated from August 2008 to February 2016 at a single referral center. Demographics, echocardiography, arterial imaging, and thrombophilia testing were collected. Statistical analysis was performed using Fisher exact test.
Results:
Across 215 cases, the median follow-up was 3.17 years (1.49, 6.46). Females comprised 42.8% of cases. Age of presentation was neonatal (110, 51.2%) or presumed perinatal (105, 48.8%). The median age at diagnosis was 2.9 days (interquartile range, 2.0-9.9) for neonatal stroke and 12.9 months (interquartile range, 8.7-32.8) for presumed perinatal stroke. Strokes were classified as arterial (149, 69.3%), venous (60, 27.9%), both (4, 1.9%), or uncertain (2, 0.9%) by consensus imaging review. Of the 215 cases, there were 6 (2.8%) recurrent ischemic cerebrovascular events. Abnormal thrombophilia testing was not associated with recurrent stroke, except for a single patient with combined antithrombin deficiency and protein C deficiency. After excluding venous events, 155 patients were evaluated for arteriopathy and cardioembolic risk factors; neither was associated with recurrent stroke. Positive family history of thrombosis was not predictive of abnormal thrombophilia testing.
Conclusions:
Thrombophilia, arteriopathy, or cardioembolic risk factors were not predictive of recurrent events after perinatal stroke. Thrombophilia evaluation in perinatal stroke should only rarely be considered.
