Headache as a risk factor for neurovascular events in pediatric brain tumor patients

Abstract

Objective: To determine whether severe recurrent headache is a risk factor for neurovascular events in children who received radiation for brain tumors.Methods: This is a retrospective cohort study of children with brain tumors who received cranial irradiation at a large tertiary care center, aged 0-21 years at diagnosis, with initial treatment between January 1, 1993 and December 31, 2002, and 2 or more follow-up visits. Patients were considered to have severe recurrent headache if this appeared as a complaint on 2 or more visits. Headaches attributed to tumor progression, shunt malfunction, or infection, or appearing at the end of life, were excluded. Medical records were reviewed for events of stroke or TIA.Results: Of 265 subjects followed for a median of 6.0 years (interquartile range 1.7-9.2 years), stroke or TIA occurred in 7/37 (19%) with severe headaches compared to 6/228 (3%) without these symptoms (hazard ratio 5.3, 95% confidence interval 1.8-15.9, p 5 0.003). Adjusting for multiple variables did not remove the significance of this risk. Median time to first neurovascular event for the entire cohort was 4.9 years (interquartile range 1.7-5.5 years). Conclusions:Severe recurrent headache appears to be a risk factor or predictor for subsequent cerebral ischemia in pediatric brain tumor survivors treated with radiation. This finding has clinical implications for both monitoring survivors and targeting a specific population for primary stroke prevention. Neurology â 2013;80:1452-1456 GLOSSARY AIS 5 arterial ischemic stroke; CI 5 confidence interval; COW 5 circle of Willis; DWI 5 diffusion-weighted imaging; HR 5 hazard ratio; RT 5 radiation therapy; SMART 5 stroke-like migraine after radiation therapy.

Pain in long‐term survivors of childhood cancer: A systematic review of the current state of knowledge and a call to action from the Children's Oncology Group

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Personality and intentional binding: an exploratory study using the narcissistic personality inventory

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Spontaneous aneurysmal subarachnoid haemorrhage in a child with multiply recurrent posterior fossa juvenile pilocytic astrocytoma

“…Cranial irradiation can cause a multitude of problems including stroke, neuroendocrine abnormality, cognitive deficit and vascular malformations 1. Children who report of severe headaches postcranial radiation have a greater risk of neurovascular events 2. While vascular complications after cranial radiotherapy are well documented, aneurysm is rare.…”