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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.

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Summary

Thrombophilia, arteriopathy, and cardiac issues do not predict recurrent perinatal stroke. Evaluation for these factors is rarely needed in pediatric stroke cases.

Keywords:
echocardiographyperinatalpregnancystrokethrombophilia

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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.