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A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Mechanisms of pediatric ischemic strokes in COVID-19: a systematic review
Elbert John V Layug1,2, Almira Doreen Abigail O Apor1, Rudolf V Kuhn3
1Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
Insights
COVID-19 can cause vasculopathy and coagulation issues, leading to pediatric ischemic strokes. This review of 74 children indicates potential links between SARS-CoV-2 infection and cerebrovascular events.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Coronavirus disease 2019 (COVID-19) is associated with cerebrovascular and thrombotic disorders in adults.
- Limited data exist on stroke in children with COVID-19, necessitating characterization of unique risk factors and pathomechanisms.
- Understanding these mechanisms is crucial for developing effective management protocols to improve outcomes in pediatric stroke patients.
Purpose of the Study:
- To characterize stroke in children with COVID-19.
- To understand the mechanisms underlying COVID-19-related pediatric ischemic strokes.
- To inform management protocols for improving outcomes in this population.
Main Methods:
- A systematic literature search was conducted in major databases (MEDLINE, EMBASE, Web of Science, Google Scholar).
- Keywords included "pediatric ischemic stroke," "cerebral sinovenous thrombosis," "SARS-CoV-2," and "COVID-19."
- Data extracted included patient demographics, clinical profiles, risk factors, neuroimaging, interventions, and outcomes.
Main Results:
- The review analyzed 52 articles comprising 74 pediatric patients with COVID-19 related stroke.
- Pediatric ischemic strokes were predominantly arterial (82.40%), with mechanisms including thrombophilia (47.3%) and vasculopathies (27%).
- Outcomes varied, with complete recoveries (13/58), residual deficits (35/58), and mortalities (10/58).
Conclusions:
- The findings support the hypothesis that SARS-CoV-2 can induce vasculopathy and coagulation derangements, predisposing children to ischemic strokes.
- This comprehensive summary of published literature highlights the clinical profiles and outcomes of pediatric ischemic stroke in the context of COVID-19.
- Further research is needed to elucidate specific pathomechanisms and optimize treatment strategies.
Background:
Coronavirus disease 2019 (COVID-19) has been shown to cause vasculopathic and hemostatic derangements predisposing to cerebrovascular and thrombotic disorders in adults. Data in children, however, are limited to case reports and series. Given the unique risk factors and potential pathomechanisms in children, it is imperative to characterize stroke in children with COVID-19. Understanding these mechanisms is essential in drafting an appropriate management protocol to improve outcomes in a population where stroke carries higher disability-adjusted life years.
Methods:
A systematic literature search was done in MEDLINE, EMBASE, Web of Science and Google Scholar using the terms "pediatric ischemic stroke," "cerebral sinovenous thrombosis," "SARS-CoV-2," and "COVID-19." Patient demographics, clinical profile, stroke risk factors, neuroimaging findings, interventions and outcomes were recorded.
Results:
The search produced 776 records. After preliminary review of titles, abstracts and selected full texts, 52 articles comprising of 74 patients were studied. The cohort has slight female predominance (51.5%), with mean age of 9.2 years (±2SD 5.6). Pediatric ischemic strokes were categorized as arterial ischemic strokes (82.40%), cerebral sinovenous thrombosis (12.20%) and combined arterial and venous strokes (5.41%). Mechanisms of ischemic stroke included thrombophilia (47.3%), vasculopathies (27%) and cardioembolism (6.8%). Twenty cases (27%) had comorbidities predisposing to stroke and only 18.9% met the criteria for multisystem inflammatory syndrome in children (MIS-C). Outcomes ranged from complete recoveries (13/58), residual deficits (35/58), and mortalities (10/58).
Conclusion:
This study presents a comprehensive summary of the currently available published literature on pediatric ischemic strokes in the background of COVID-19. The clinical profiles and outcomes of patients reviewed support prior hypotheses that the virus can cause both a vasculopathy and induce a derangement in the coagulation system, predisposing to ischemic strokes.
Study Registration:
This paper's protocol has been registered in PROSPERO with ID number CRD42022315219.
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