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Subtypes of ischemic stroke in children and young adults
L S Williams1, B P Garg, M Cohen
1Department of Neurology, Indiana University School of Medicine, Indianapolis 46202, USA.
Insights
Understanding stroke causes in children and young adults is key for prevention. Children more often have prothrombotic causes, while young adults experience more dissections and atherothrombotic strokes.
Area of Science:
- Neurology
- Pediatric Neurology
- Vascular Neurology
Background:
- Effective stroke prevention strategies require detailed understanding of stroke causes in pediatric and young adult populations.
- Ischemic stroke in younger individuals presents unique etiological profiles compared to older adults.
Purpose of the Study:
- To describe and compare the causes and subtypes of acute ischemic stroke in children (1-18 years) and young adults (19-45 years).
- To identify age-specific differences in stroke etiology to inform targeted prevention efforts.
Main Methods:
- Utilized ICD-9 codes for pediatric acute ischemic stroke cases and dedicated registries for young adults.
- Classified ischemic stroke subtypes using validated criteria: atherothrombotic (AT), cardioembolic (CE), small-vessel (SV), other determined, and unknown.
- Analyzed demographic and etiological data for 92 children and 116 young adults.
Main Results:
- Significant differences observed in stroke subtypes: AT strokes were more common in young adults (16%) than children (0%), while prothrombotic causes were more frequent in children (25% vs 14%).
- Young adults showed higher rates of dissection (15% vs 3%).
- Stroke etiology was less frequently identified in children (unknown cause 36%) compared to young adults (23%).
Conclusions:
- The etiological profile of ischemic stroke differs between children and young adults, with distinct prevalent causes.
- The age of 15 serves as a potential transition point where stroke causes in adolescents resemble those in young adults.
- Establishing age-specific etiological understanding is crucial for developing tailored primary and secondary stroke prevention strategies in these demographics.
Abstract:
Specific strategies for primary and secondary stroke prevention in children and young adults can only be recommended once the causes of stroke in these age groups are well described. ICD-9 codes were used to identify children aged 1 to 18 years with acute ischemic stroke. Young adults aged > 18 to 45 years were identified from the Indiana University and Northwestern University Young Adults Stroke Registries. Validated criteria were used to subtype ischemic stroke as atherothrombotic (AT), cardioembolic (CE), small-vessel (SV), other determined cause, or unknown cause. Ninety-two children and 116 young adults were identified. Stroke subtypes in children/young adults (percentages) were as follows: AT 0/16 (p < 0.001), CE 15/14 (p = 1.0), SV 0/3 (p = 0.26), other 49/44 (p = 0.40), and unknown 36/23 (p = 0.04). Children had more prothrombotic causes (25% versus 14%, p = 0.03), and young adults had more dissections (3% versus 15%, p = 0.005). Children aged 15 to 18 years had causes of ischemic stroke more similar to those in young adults. The cause of ischemic stroke is less often identified in children than it is in young adults. Children have more prothrombotic causes of stroke, and adults have more atherothrombotic causes and dissections. Lacunar strokes are rare in both children and young adults. The age of 15 years should be used to separate childhood from young-adult ischemic stroke.