The First Three Years of the Swiss Neuropaediatric Stroke Registry (SNPSR): A Population-Based Study of Incidence, Symptoms and Risk Factors

Steinlin, Maja; Pfister, I.; Pavlovic, J; Everts, Regula; Boltshauser, Eugen; Mori, Andrea; Mercati, Danielle; Hänggeli, C.-A.; Keller, E; Luetschg, Juerg; Jp, Marcoz; Gp, Ramelli; Perez, E. Roulet; Schmitt‐Mechelke, Thomas; Weissert, M

doi:10.1055/s-2005-837658

Cited by 172 publications

(190 citation statements)

References 30 publications

(64 reference statements)

Supporting

Mentioning

160

Contrasting

Unclassified

Order By: Relevance

“…16 The [CT] and ⁄ or magnetic resonance imaging [MRI], MR or CT angiography ⁄ venography were not mandatory), and age younger than 16 years. The participants were divided into two age groups: neonates (diagnosis of CSVT within 28d of life) and children (diagnosis of CSVT after 28d of life).…”

Section: Methods Participants and Data Collectionmentioning

confidence: 99%

See 1 more Smart Citation

Cerebral sinus venous thrombosis in Swiss children

Grunt

Wingeier

Wehrli

et al. 2010

Develop Med Child Neuro

101

View full text Add to dashboard Cite

AIM To describe the characteristics of paediatric cerebral sinus venous thrombosis (CSVT) inSwitzerland.METHOD Data on clinical features, neuroimaging, risk factors, and treatment were collected for all children in Switzerland younger than 16 years of age who had CSVT between January 2000 and December 2008. A follow-up examination and a cognitive assessment were performed (mean follow-up period 26mo). Differences between neonates and children (patients older than 28d) were assessed and predictors of outcome were determined.RESULTS Twenty-one neonates (14 males, seven females; mean age 9d, SD 8d) and 44 children (30 males, 14 females; mean age 8y 7mo, SD 4y 5mo) were reported. The incidence of paediatric CSVT in Switzerland was 0.558 per 100 000 per year. In neonates, the deep venous system was more often involved and parenchymal injuries were more common. The strongest predictor of poor outcome was neonatal age (odds ratio 17.8, 95% confidence interval 0. 847-372.353). Most children showed global cognitive abilities within the normal range, but impairments in single cognitive subdomains were frequent.INTERPRETATION Paediatric CSVT is rare. Its outcome is poor in neonates. Most children have good neurological outcomes, but some patients have individual neuropsychological impairments.Cerebral sinus venous thrombosis (CSVT) in children is rare. Based on a Canadian registry, its incidence is 0.67 cases per 100 000 children per year; neonates were the most commonly affected.1 The risk factors in neonates include maternal conditions, delivery complications, and neonatal comorbidities. [1][2][3][4] Older children often use prothrombotic agents such as oral contraceptives or suffer from infections of the head and neck or a chronic systemic illness.5-8 Prothrombotic states are increased in patients who suffer from CSVT.1,9 The superficial venous system is most commonly involved. 1,6,10 Parenchymal injuries, such as ischaemic or haemorrhagic infarcts, are often observed in conjunction with CSVT. [1][2][3]11,12 One-third of term neonates with intraventricular haemorrhage suffer from CSVT. 13Two to 10 per cent of the neonates 2,4 and 11 to 17% of the older children died after CSVT 2,6 . A recurrence of the thrombosis occurred in 6%.10 Thirty-eight per cent of the patients exhibited neurological deficits, such as motor impairment, cognitive problems, or epilepsy.1 The long-term outcome was especially poor in neonates. 1,2,4 In older children who suffered from CSVT, cognitive assessments with standardized and agenormalized tests showed cognitive performance within the normal range, 14,15 but individual impairments were seen in up to 20% of the patients. 14In the present study, we aimed to describe the incidence, clinical manifestation, neuroimaging findings, risk factors, and treatment of children suffering from CSVT in Switzerland. In addition, we systematically assessed outcomes after CSVT and identified predictors of poor outcome. METHOD Participants and data collectionThe Swiss Neuropaediatric Stroke Registry (SNPSR) is a...

show abstract

Section: Methods Participants and Data Collectionmentioning

confidence: 99%

“…16 Normal values for these tests were determined by the local laboratories that performed the investigations. The SNPSR did not provide any recommendations for the treatment of CSVT.…”

mentioning

confidence: 99%

Cerebral sinus venous thrombosis in Swiss children

Grunt

Wingeier

Wehrli

et al. 2010

Develop Med Child Neuro

101

View full text Add to dashboard Cite

show abstract

“…[6][7][8] At the same time, it is a serious disorder with deficits evident in 70% of children, both acutely 9 and in long-term follow-up. [10][11][12] In addition, recurrence is common, with a cumulative probability of recurrent stroke of 6-15% at approximately 1 year. 6,13 Numerous causal and contributing factors have been identified in childhood-onset AIS, including thrombophilia (i.e., hypercoagulability), acute infection, congenital heart disease, cardiac catheterization, cerebral/cervical arterial dissection, cerebral angiitis, and other/idiopathic cerebral arteriopathies.…”

Section: Introductionmentioning

confidence: 99%

Elevated lipoprotein (a), small apolipoprotein (a), and the risk of arterial ischemic stroke in North American children

et al. 2013

View full text Add to dashboard Cite

Lipoprotein (a) is a risk factor for adult cardiovascular events, in which the apolipoprotein (a) component is thought to promote atherogenesis and impair fibrinolysis. We investigated whether elevated plasma lipoprotein (a) concentration and small predominant apolipoprotein (a) isoform size (number of kringle-4 domains) are risk factors for childhood arterial ischemic stroke and correlate with plasma fibrinolytic function. Patients who had had an arterial ischemic stroke in childhood (29 days -<21 years at onset; n=43) and healthy controls (n=127) were recruited for plasma sampling and laboratory determinations. Cases were followed for recurrence in a prospective cohort study. The median lipoprotein (a) concentration did not differ between groups [cases: median 18.0 nmol/L (7.5 mg/dL) and observed range 0.9-259 nmol/L (0.38-108.0 mg/dL), controls: 20.4 nmol/L (8.5 mg/dL) and 0.2-282 nmol/L (0.08-117.5 mg/dL); P=0.62]. While odds of incident stroke were not significantly increased, risks of recurrent arterial ischemic stroke were each more than ten-times increased for lipoprotein(a) >90 th percentile of racespecific reference values and apolipoprotein (a) <10 th percentiles [odds ratio=14.0 (95% confidence interval: 1.0-184), P=0.05 and odds ratio=12.8 (1.61-101), P=0.02]. Statistically significant but weak correlations were observed between euglobulin lysis time and both lipoprotein (a) level (r=0.18, P=0.03) and apolipoprotein (a) size (r= -0.26, P=0.002). In conclusion, elevated lipoprotein (a) and small apolipoprotein (a) potently increase the risk of recurrent arterial ischemic stroke in children, with a mechanism only partially attributable to impaired fibrinolysis. Collaborative studies are warranted to investigate these findings further and, more broadly, to establish key risk factors for incident and recurrent arterial ischemic stroke in children. More recently, in a study in the USA, 17 the prevalence of elevated Lp(a) among 59 children with porencephaly or a history of perinatal or childhood onset-AIS was significantly increased compared to that of historical controls who had consisted of healthy German children (20% versus 5.4%); however, concomitant USAbased controls were lacking. Interestingly, in a French study of mother-infant diads of neonatal AIS, elevated maternal Lp(a) was not only implicated in perinatal AIS but also correlated with low birth weight in these infants, leading to a hypothesis that elevated Lp(a) may mediate placental insufficiency. Elevated lipoprotein (a), small apolipoprotein (a), and the risk of arterial ischemic stroke in North American children18 With regard to recurrent AIS in childhood, a prospective multicenter cohort study in Germany 13 demonstrated that Lp(a) >30 mg/dL was an independent risk factor for recurrent AIS (OR: 2.8; 95% CI: 1.1-7.5).In consideration of the lack of well-controlled studies of Lp(a) in childhood-onset AIS outside of Germany, and given also that apo(a) size has received little attention in pediatric AIS, we sought to determine the odds of inci...

show abstract

“…Focal motor weakness is the initial symptom in the majority (70-80%) of pediatric AIS patients [115,118]. Recent studies have not found an association between the presenting clinical symptom and the length of delay in medical evaluation or diagnosis of stroke [111,116].…”

Section: Pediatric Strokementioning

confidence: 99%

Pediatric Neurocritical Care

Murphy

2012

Neurotherapeutics

View full text Add to dashboard Cite

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.

show abstract

The First Three Years of the Swiss Neuropaediatric Stroke Registry (SNPSR): A Population-Based Study of Incidence, Symptoms and Risk Factors

Cited by 172 publications

References 30 publications

Cerebral sinus venous thrombosis in Swiss children

Cerebral sinus venous thrombosis in Swiss children

Elevated lipoprotein (a), small apolipoprotein (a), and the risk of arterial ischemic stroke in North American children

Pediatric Neurocritical Care

Contact Info

Product

Resources

About