Stroke in Childhood: Outcome and Recurrence Risk by Mechanism in 59 Patients

Abstract

This paper describes 59 patients, 3 months to 16 years of age, who were seen consecutively in the same center for cerebral arterial infarction. It focuses on the mechanism of stroke. The pathophysiologic process could be established for 78% of the children. Arteriopathic stroke (31 patients, or 53%) was the most common. The arteriopathies were either progressive (moyamoya in 4 patients, or 7%) or nonprogressive (27 patients, or 46%). The latter form occurred in two patterns: dissection of cervicocephalic arteries (12 patients, or 20%) and transient cerebral arteriopathy of unknown origin but probably angiitis (15 patients, or 25%). Cardiac or transcardiac embolic stroke occurred in 12% of the series and systemic diseases in 14%. There was a favorable outcome in 70% of patients having stroke due to nonprogressive arterial disease and stroke due to unidentified mechanisms. In contrast, only 26% of patients with embolic stroke, systemic disease, or moyamoya had a favorable outcome. Recurrences were more frequent and severe in this latter group. It is concluded that it is important to determine the mechanism of childhood stroke, because it strongly influences outcome, the recurrence risk, and treatment choice.

Therapeutic approaches and advances in pediatric stroke

“…3,6,8 In older infants and children, risk factors are identified in 70 to 90% of children. 3,9,10,11 About half of children have no prior significant medical history. 11 While over 100 different risk factors for pediatric stroke have been suggested, 7 causal relationship to AIS has not necessarily been proven.…”

“…9,11,12 Arterial dissection may be related to trauma or can occur spontaneously in both the anterior and posterior circulations. 13,14 Moyamoya describes the "puff of smoke" appearance on angiography created by collateral vessels that develop secondary to a bilateral, progressive, proximal, non-inflammatory arteriopathy of the distal internal carotid artery.…”

“…61 Cerebral angiography remains the gold standard for neurovascular imaging in children, and may be required for certain diagnoses. 9,13,24,59 . Radiological diagnosis of childhood CSVT is challenging and is reviewed elsewhere.…”

Therapeutic approaches and advances in pediatric stroke

“…9,10,115,116 Recurrence risk is maximal in the first six months, and is increased in the presence of vasculopathy or multiple risk factors. 9,10,56 Certain prothrombotic disorders 56 carry an increased recurrence risk while others do not. 117 In perinatal AIS recurrence rates are less than 5%.…”

Diagnostic pitfalls in paediatric ischaemic stroke

“…Causes and risk factors are diverse and differ substantially from those in adults (DeVeber 2003a). A correct aetiological diagnosis is important because it guides the selection of acute treatment and secondary prevention strategies, and it determines the prognosis and recurrence risk (Chabrier et al 2000, Lanthier et al 2000, DeVeber 2003a.…”