Stroke in Children Within a Major Metropolitan Area: The Surprising Importance of Intracerebral Hemorrhage

Broderick, Joseph P.; Talbot, G. Theodore; Prenger, Erin; Leach, Andrew; Brott, Thomas G.

doi:10.1177/088307389300800308

Cited by 301 publications

(201 citation statements)

References 12 publications

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“…This incidence is comparable to the incidence of stroke found among patients with sickle cell anemia and more than 1000 times the 2.7-3.3 cerebral infarctions and subarachnoid hemorrhages per 100,000 children per year. 1,20,21 To our knowledge, this is the first report of the incidence of nonperioperative stroke among children with CNS tumors and demonstrates that they are much more frequent in this patient population.…”

Section: Discussionmentioning

confidence: 78%

“…The incidence of stoke during childhood in the United States is 2.7-3.3 strokes per 100,000 patient years. 1,2 Strokes are believed to be more common among children with central nervous system (CNS) tumors. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] However, existing reports of stroke among children with CNS tumors do not include a control study population and therefore do not allow for the determination of the incidence of stroke nor identify risk factors for their occurrence.…”

mentioning

confidence: 99%

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Nonperioperative strokes in children with central nervous system tumors

Bowers

Mulne

Reisch

et al. 2002

Cancer

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BACKGROUNDNonperioperative strokes are rare yet potentially devastating events for children with central nervous system (CNS) tumors. The incidence of and risk factors for nonperioperative strokes in children with CNS tumors is unknown.METHODSThe authors performed a retrospective review of children from their institution with CNS tumors. The incidence of stroke in the nonperioperative period and the influence of patient demographic factors, coexisting genetic diseases, tumor type, and treatment modality on the subsequent occurrence of a stroke were determined.RESULTSEight hundred seven consecutive patients from the authors' institution with CNS tumors were observed for a combined 3224 nonperioperative years. Thirteen patients (1.6%) had a nonperioperative stroke, for an incidence of 4.03 strokes/1000 years of nonperioperative patient follow‐up. Eight patients were males, and the median age at diagnosis of a CNS tumor was 4.8 years (range, 0.3–18.6 years). The median duration from diagnosis of a CNS tumor until the occurrence of stroke was 2.3 years (range, 0.3–15.8 years). Among numerous potential risk factors individually examined by chi‐square analysis, only treatment with radiation therapy was associated with the subsequent development of a stroke (chi‐square, P = 0.007). By logistic regression analysis, treatment with radiation therapy and a diagnosis of an optic pathway glioma were the only statistically significant variables associated with a stroke.CONCLUSIONSStrokes are much more common among children with CNS tumors. Children treated with radiation therapy and those with optic pathway gliomas have a higher association with the occurrence of a subsequent nonperioperative stroke. Because children with optic pathway gliomas may be at particularly high risk of stroke after radiation therapy, the desired beneficial therapeutic effects of irradiation must always be weighed against its potentially adverse effects, including stroke. Cancer 2002;94:1094–101. © 2002 American Cancer Society.DOI 10.1002/cncr.10353

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Section: Discussionmentioning

confidence: 78%

mentioning

confidence: 99%

Nonperioperative strokes in children with central nervous system tumors

Bowers

Mulne

Reisch

et al. 2002

Cancer

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“…Perinatal strokes have a unique presentation and risk factors, and comprise a significant portion of pediatric stroke taken as a whole [103]. In adults, ischemic strokes predominate, whereas in children, intracerebral hemorrhage and ischemic stroke are more evenly represented [104][105][106][107]. Cerebral sinovenous thrombosis is most common in the neonatal population and has a reported incidence of 1 of 100,000 children per year [108].…”

Section: Pediatric Strokementioning

confidence: 99%

Pediatric Neurocritical Care

Murphy

2012

Neurotherapeutics

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Pediatric neurocritical care is an emerging multidisciplinary field of medicine and a new frontier in pediatric critical care and pediatric neurology. Central to pediatric neurocritical care is the goal of improving outcomes in critically ill pediatric patients with neurological illness or injury and limiting secondary brain injury through optimal critical care delivery and the support of brain function. There is a pressing need for evidence based guidelines in pediatric neurocritical care, notably in pediatric traumatic brain injury and pediatric stroke. These diseases have distinct clinical and pathophysiological features that distinguish them from their adult counterparts and prevent the direct translation of the adult experience to pediatric patients. Increased attention is also being paid to the broader application of neuromonitoring and neuroprotective strategies in the pediatric intensive care unit, in both primary neurological and primary non-neurological disease states. Although much can be learned from the adult experience, there are important differences in the critically ill pediatric population and in the circumstances that surround the emergence of neurocritical care in pediatrics.

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“…While population-based studies and national registries have provided useful information on the overall incidence of childhood stroke, neonatal and perinatal events have often been excluded from these studies (Broderick et al, 1993). Similarly, studies of neonatal thrombosis have not always included central nervous system events and the total number of cases included in these registries has often been small (Schmidt & Andrew, 1995;Nowak-Gottl et al, 1997).…”

Section: Incidence Of Aismentioning

confidence: 99%

Perinatal stroke – risk factors and management

Chalmers

2005

Br J Haematol

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SummaryStroke is an uncommon but increasingly recognised cause of mortality and long-term neurological morbidity in children. A significant number of these events appear to be caused by thromboembolic disease and, as with other childhood thrombotic problems, the incidence of central nervous system events appears highest during the neonatal period. In contrast to peripheral arterial and venous thrombotic problems, it is likely that a proportion of cerebral thromboembolic events occur either in utero or perinatally and reflect different risk factors from those occurring in older infants and children. The pathophysiology of perinatal stroke is complex and in many cases is likely to be multifactorial. It is now recognised that risk factors may relate to both maternal and placental problems as well as fetal and neonatal disorders. Large prospective studies of perinatal stroke are currently lacking and efforts to define the relative contribution from each of these areas are at an early stage. The complex nature of these disorders requires collaboration between a number of different disciplines including obstetrics, fetal medicine, pathology, neonatology and neurology. Of particular interest to haematologists is the possible impact of prothrombotic abnormalities in the pathophysiology of these events and also the potential for the use of antithrombotic agents in both management and prevention.

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Stroke in Children Within a Major Metropolitan Area: The Surprising Importance of Intracerebral Hemorrhage

Cited by 301 publications

References 12 publications

Nonperioperative strokes in children with central nervous system tumors

Nonperioperative strokes in children with central nervous system tumors

Pediatric Neurocritical Care

Perinatal stroke – risk factors and management

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