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Antiphospholipid antibodies in cerebrovascular ischemia and stroke in childhood
M Schöning1, R Klein, I Krägeloh-Mann
1Division of Neuropediatrics, Children's Hospital, Tübingen, Germany.
Insights
Pediatric stroke may be linked to antiphospholipid antibodies (APLA). Testing children with cerebrovascular events for APLA is recommended due to potential links and the evolving understanding of antiphospholipid syndrome.
Area of Science:
- Pediatric Neurology
- Immunology
- Vascular Medicine
Background:
- Cerebrovascular ischemia and stroke are rare in children.
- Traditional risk factors for adult stroke are often absent in pediatric cases.
- The role of antiphospholipid antibodies (APLA) in pediatric cerebrovascular events requires further investigation.
Observation:
- Eight children aged 2-11 years experienced cerebrovascular ischemia or stroke.
- Antiphospholipid antibodies (APLA) were detected in all eight children, either during the event or follow-up.
- Associated findings included multiple cerebral artery stenoses, moyamoya syndrome, and mycoplasmal infection.
- APLA positivity was observed in parents of three patients.
- Treatment with acetylsalicylic acid and immunoglobulin infusions showed limited efficacy, except for one case of moyamoya syndrome.
Findings:
- A significant association between pediatric stroke/transient ischemic attacks and antiphospholipid antibodies (APLA) is suggested.
- The presence of APLA in children with cerebrovascular events warrants further research into their pathogenic role.
- Pediatric stroke research may provide unique insights into the antiphospholipid syndrome.
Implications:
- Routine testing for antiphospholipid antibodies (APLA) in children experiencing stroke or transient ischemic attacks is proposed.
- This recommendation aims to improve diagnosis and understanding of pediatric cerebrovascular diseases.
- Further research is needed to elucidate the causal relationship between APLA and pediatric stroke.
Abstract:
We report on eight children who suffered from cerebrovascular ischemia or stroke at the age of 2 or up to 11 years. Antiphospholipid antibodies (APLA) were detected in two cases during the ischemic event and in six cases during follow-up examinations (after six weeks or within a span of six years). In two patients multiple stenoses of basal cerebral arteries were found; one of them suffered from moyamoya syndrome. The acute hemiplegia in one patient was linked to an asymptomatic mycoplasmal infection and APLA. In three cases, one of the parents was also APLA-positive. Seven patients were treated with acetylsalicylic acid, and in four cases immunoglobulin infusions were given. Transient ischemic attacks subsided after the child with the moyamoya syndrome received immunoglobulins. No effect of medication could be established in the other children. The concept of the antiphospholipid syndrome is still evolving. As none of the common risk factors pertaining to strokes in adults apply to children, pediatric research may offer a suitable platform for specific investigations on the causal, pathogenetic role of APLA. We propose that all children suffering from stroke or transient ischemic attacks should be tested for APLA.