Recurrence Rate and Outcome of Varicella-Associated Childhood Stroke: A Nationwide Population-Based Study and
Nicol Dara Matoor1, Thomas Truelsen2, Malene Landbo Boerresen3
1Department of Neurology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
Insights
Varicella-zoster virus is a significant risk factor for childhood arterial ischemic stroke (AIS), leading to potential neurological deficits but generally good functional outcomes and a low recurrence risk.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Vascular Neurology
Background:
- Varicella-associated arterial ischemic stroke (AIS) in children requires further investigation regarding recurrence and clinical outcomes.
- Denmark's lack of universal varicella vaccination provides a unique setting for cohort studies.
Purpose of the Study:
- To examine the recurrence rate and clinical outcomes of AIS in children with varicella.
- To systematically review existing literature on varicella-associated AIS in pediatric populations.
Main Methods:
- Nationwide cohort study in Denmark (2011-2023) identifying children with varicella-associated AIS.
- Systematic review of PubMed and Embase (2000-2023) for studies on pediatric varicella-associated AIS recurrence.
- Data extraction from medical records and analysis of registry data.
Main Results:
- Varicella-associated AIS occurred in 17.7% of children with AIS in the cohort.
- Two out of 32 children (6.3%) experienced stroke recurrence within a median follow-up of 5.2 years.
- Despite high rates of neurological deficits (65.6%), 90.6% achieved good functional outcomes.
Conclusions:
- Varicella-zoster virus is a key risk factor for pediatric AIS, associated with significant neurological deficits but favorable functional recovery.
- Recurrence rates in the literature vary, potentially due to sample size and methodological differences.
- The study highlights the importance of understanding varicella-associated AIS for improved secondary prevention strategies.
Background:
We performed a nationwide cohort study and systematic review to examine recurrence rate and clinical outcome in children with varicella-associated arterial ischemic stroke (AIS).
Methods:
The cohort study included children with varicella-associated AIS (varicella <12 months before stroke and/or confirmed varicella-zoster virus in cerebrospinal fluid) and was conducted in Denmark, a country without universal varicella-vaccination. The children were identified by searching the Danish National Patient Registry (2011-2020) and by registration of children assessed through a regional stroke triage-setup (2021-2023). Clinical data were extracted from medical records. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. PubMed and Embase were searched for studies published from January 1, 2000, to June 26, 2023, reporting on recurrence rate in children (age < 18 years) with varicella-associated AIS.
Results:
In the cohort study, varicella-associated AIS was present in 32 of 181 (17.7%) children with AIS. Thirty-two children were treated with aspirin, 30 (93.8%) with antivirals, and 21 (65.6%) with steroids. Angiography descriptions were retrieved in 30 children and showed unifocal or multifocal stenoses in 12 (40%). Within median follow-up of 5.2 years, two (6.3%) children experienced stroke recurrence. Long-term deficits were observed in 21 (65.6%) children, but 29 (90.6%) achieved good functional outcomes. The systematic review yielded three eligible studies, including a total of 68 children. Reported recurrence rates ranged from 9.1 to 45.5% across studies.
Conclusions:
This study demonstrates that varicella-zoster virus is an important AIS risk factor associated with a high risk of neurological deficits but a good functional outcome and low recurrence risk. Reported recurrence rates vary across the literature, likely reflecting small sample sizes but also differences in methodology and secondary prevention.
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