A right-to-left shunt and prothrombotic disorders in pediatric patients presenting with transient ischemic attack

Perkovič-Benedik, Mirjana; Zaletel, Marjan; Pečarič-Meglič, Nuška; Podnar, Tomaž

doi:10.1007/s00431-012-1875-5

Cited by 10 publications

(10 citation statements)

References 17 publications

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“…There is a shortage of data regarding the implication of PFO in the child population [13,14]. Ischaemic cerebrovascular events are relatively rare in this group of patients, but they are increasingly recognised [15,16], resulting in disability and mortality.…”

Section: Discussionmentioning

confidence: 99%

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Efficiency of transcatheter patent foramen ovale closure in children after paradoxical embolism events

et al. 2016

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A b s t r a c tBackground and aim: Patent foramen ovale (PFO) may result in a cerebrovascular event -a presumed paradoxical embolism (PE). However, the presence of this phenomenon among paediatric patients was rarely evaluated. Transcatheter PFO closure was considered to be a method of treatment in such patients. Methods:For evaluation clinical data and long-term outcome, we reviewed records of patients below 18 years of age, with history of cerebrovascular event related to PE, who underwent procedure of percutaneous PFO closure in years 1999-2014 in our department.Results: Among 230 patients with cerebrovascular events who had PFO closed percutaneously, seven children (aged 12--16 years, five male) were selected. Indications for closure were cryptogenic stroke in two patients and transient ischaemic attack (TIA) in five patients. Diagnosis of PFO was established by transthoracic echocardiography, with right-to-left shunt (RLS) through PFO confirmed by transoesophageal echocardiography. Contrast transcranial Doppler (c-TCD) was performed preprocedurally in four patients, revealing significant RLS. For percutaneous closure of PFO different occluders (Starflex, Amplatzer PFO devices, Cardio-O-Fix) were used. Closure was successfully completed in all patients and no procedure-related complications were observed. Postprocedural c-TCD six months after closure revealed no significant RLS. During follow-up (3 to 10 years) one patient had an episode of recurrent TIA; however, in this patient paroxysmal atrial fibrillation was found during the follow-up period. Conclusions:Cerebral embolism due to PFO is uncommon in children. Transcatheter PFO closure in this group of patients is a safe and effective procedure. C-TCD is plausible technique for detection RLS and monitoring PFO closure efficacy in this group of patients.

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Section: Discussionmentioning

confidence: 99%

“…Benedik et al [14] underline the lack of data regarding PFO closure in such young patients. In RCTs only patients over 18 years old were included [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

Efficiency of transcatheter patent foramen ovale closure in children after paradoxical embolism events

et al. 2016

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“…Another study reports prothrombotic abnormalities present in 20-50 % of children with arterial ischemic stroke [22,35].…”

Section: Prothrombotic Disordersmentioning

confidence: 98%

“…Predisposing conditions for ischemic cerebrovascular accidents in children include congenital heart malformations (congenital cyanotic complex heart malformations or acquired heart disease), sickle cell disease, infections, and collagen tissue abnormalities [13], but around half occur in children who were previously well (cryptogenic stroke) [14]. It is well known from literature, that one of the most common conditions associated with AIS is congenital heart malformations (like patent foramen ovale) [15][16][17][18][19][20][21][22][23][24][25].…”

Section: Etiologymentioning

confidence: 99%

Cerebral hemorrhagic infarction as the initial manifestation of deep venous thrombosis in a child with patent foramen ovale: A case report

Panagopoulos¹,

Loukopoulou²,

Markogiannakis³

et al. 2017

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.comCerebral hemorrhagic infarction as the initial manifestation of deep venous thrombosis in a child with patent foramen ovale: A case report Dimitrios Panagopoulos, Sofia Loukopoulou, Georgios Markogiannakis, Nikos Eleftherakis ABSTRACT Introduction: Arterial ischemic stroke (AIS), with an estimated incidence of 1.1-4.3 per 100,000, is an important cause of morbidity and mortality in children and the recurrence risk is high. Case Report: We present the case of an 11-year-old child who presented with a symptomatology of acute ischemic stroke of unknown etiology. The radiological investigation did not reveal any underlying brain abnormality that could cause the event. The diagnostic work up included an echocardiogram, which revealed a thrombus in the right atrium, in conjunction with a patent foramen ovale. The patient was initiated immediately on anticoagulation therapy with low molecular weight heparin and warfarin, but two days later she suffered pulmonary emboli, diagnosed with spiral thorax computed tomography scan. An ultrasound study of the vessels of the lower extremities revealed deep venous thrombosis, which was considered to be the underlying causative mechanism. Conclusion: To the best of our knowledge, this is the first documented case of right atrial thrombus resulting from deep venous thrombosis in a pediatric patient with patent foramen ovale and associated ischemic stroke event. A discussion regarding the definition of cryptogenic stroke, its etiology and relationship with deep venous thrombosis and the currently proposed therapy, follows.

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“…However, TIA in children has been associated with moyamoya arteriopathy, sickle cell anemia, thrombophilia, congenital heart disease, and intracardiac right to left shunt. 3,[7][8][9] Thus, the pathophysiology of TIA in children may also be different than in adults.…”

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confidence: 99%

Predictors of Stroke After Transient Ischemic Attack in Children

Lehman

Watson

Kapur

et al. 2016

Stroke

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Background and Purpose-Transient ischemic attack (TIA) in children has received far less attention compared with TIA in adults. The risk factors of stroke after TIA in children are relatively unknown. We aimed to determine the percentage of children who have stroke after TIA and the risk factors associated with stroke after TIA. Methods-We searched the medical records at Boston Children's Hospital for the year 2010 to find children who were evaluated for TIA to determine associated risk factors of stroke after TIA. We included children who were evaluated in 2009 through 2010 for TIA and had magnetic resonance imaging. We examined follow-up imaging through August 2014 for subsequent stroke. Logistic regression was used to calculate odds ratios for factors in our cohort who are associated with stroke after presentation with TIA. Results-We identified 63 children who experienced a TIA. The mean time of imaging follow-up was 4.5 years after TIA presentation. Of the 63 children, 10 (16%) developed radiological evidence of ischemic cerebral injury within the followup period. Four of the 10 (6%) demonstrated diffusion abnormalities on magnetic resonance imaging at TIA presentation, whereas 8 (13%) had a stroke after their TIA. Arteriopathy, female sex, and autoimmune disorders were significantly associated with stroke after TIA. Conclusions-In our cohort of children, stroke occurred after TIA at a rate similar to that seen in adults, but the risk factors for stroke after TIA in children are different.

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A right-to-left shunt and prothrombotic disorders in pediatric patients presenting with transient ischemic attack

Cited by 10 publications

References 17 publications

Efficiency of transcatheter patent foramen ovale closure in children after paradoxical embolism events

Efficiency of transcatheter patent foramen ovale closure in children after paradoxical embolism events

Cerebral hemorrhagic infarction as the initial manifestation of deep venous thrombosis in a child with patent foramen ovale: A case report

Predictors of Stroke After Transient Ischemic Attack in Children

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