Skip to main content
Top
Published in: Current Atherosclerosis Reports 4/2010

Open Access 01-07-2010

Recent Advances in Childhood Arterial Ischemic Stroke

Authors: Christine K. Fox, Heather J. Fullerton

Published in: Current Atherosclerosis Reports | Issue 4/2010

Login to get access

Abstract

Although many underlying diseases have been reported in the setting of childhood arterial ischemic stroke, emerging research demonstrates that non-atherosclerotic intracerebral arteriopathies in otherwise healthy children are prevalent. Minor infections may play a role in arteriopathies that have no other apparent underlying cause. Although stroke in childhood differs in many aspects from adult stroke, few systematic studies specific to pediatrics are available to inform stroke management. Treatment trials of pediatric stroke are required to determine the best strategies for acute treatment and secondary stroke prevention. The high cost of pediatric stroke to children, families, and society demands further study of its risk factors, management, and outcomes. This review focuses on the recent findings in childhood arterial ischemic stroke.
Literature
1.
go back to reference Agrawal N, Johnston SC, Wu YW, et al. Imaging data reveal a higher pediatric stroke incidence than prior US estimates. Stroke 2009;40:3415–3421.CrossRefPubMed Agrawal N, Johnston SC, Wu YW, et al. Imaging data reveal a higher pediatric stroke incidence than prior US estimates. Stroke 2009;40:3415–3421.CrossRefPubMed
2.
go back to reference Lo W, Stephens J, Fernandez S. Pediatric stroke in the United States and the impact of risk factors. J Child Neurol 2009;24:194–203.CrossRefPubMed Lo W, Stephens J, Fernandez S. Pediatric stroke in the United States and the impact of risk factors. J Child Neurol 2009;24:194–203.CrossRefPubMed
3.
go back to reference Golomb MR, Fullerton HJ, Nowak-Gottl U, Deveber G. Male predominance in childhood ischemic stroke: findings from the international pediatric stroke study. Stroke 2009;40:52–57.CrossRefPubMed Golomb MR, Fullerton HJ, Nowak-Gottl U, Deveber G. Male predominance in childhood ischemic stroke: findings from the international pediatric stroke study. Stroke 2009;40:52–57.CrossRefPubMed
4.
go back to reference Normann S, de Veber G, Fobker M, et al. Role of endogenous testosterone concentration in pediatric stroke. Ann Neurol 2009;66:754–758.CrossRefPubMed Normann S, de Veber G, Fobker M, et al. Role of endogenous testosterone concentration in pediatric stroke. Ann Neurol 2009;66:754–758.CrossRefPubMed
5.
go back to reference Mackay M, Wiznitzer M, Benedict S, et al. Risk factors for childhood arterial ischemic stroke: results from the International Pediatric Stroke Study [abstract]. Presented at International Stroke Conference 2010. San Antonio, TX; February 24–26, 2010. Mackay M, Wiznitzer M, Benedict S, et al. Risk factors for childhood arterial ischemic stroke: results from the International Pediatric Stroke Study [abstract]. Presented at International Stroke Conference 2010. San Antonio, TX; February 24–26, 2010.
6.
go back to reference Fullerton HJ, Wu YW, Sidney S, Johnston SC. Risk of recurrent childhood arterial ischemic stroke in a population-based cohort: the importance of cerebrovascular imaging. Pediatrics 2007;119:495–501.CrossRefPubMed Fullerton HJ, Wu YW, Sidney S, Johnston SC. Risk of recurrent childhood arterial ischemic stroke in a population-based cohort: the importance of cerebrovascular imaging. Pediatrics 2007;119:495–501.CrossRefPubMed
7.
go back to reference • Amlie-Lefond C, Bernard TJ, Sebire G, et al. Predictors of cerebral arteriopathy in children with arterial ischemic stroke: results of the International Pediatric Stroke Study. Circulation 2009;119:1417–1423 Results from the International Pediatric Stroke Study of 525 children with vascular imaging after an arterial ischemic stroke demonstrate the importance of arteriopathies. The term “focal cerebral arteriopathy” is suggested to describe the common finding of focal cerebral arterial stenosis with no apparent cause. Prior upper respiratory infection was associated with focal cerebral arteriopathy, supporting the role of infection in childhood stroke.CrossRefPubMed • Amlie-Lefond C, Bernard TJ, Sebire G, et al. Predictors of cerebral arteriopathy in children with arterial ischemic stroke: results of the International Pediatric Stroke Study. Circulation 2009;119:1417–1423 Results from the International Pediatric Stroke Study of 525 children with vascular imaging after an arterial ischemic stroke demonstrate the importance of arteriopathies. The term “focal cerebral arteriopathy” is suggested to describe the common finding of focal cerebral arterial stenosis with no apparent cause. Prior upper respiratory infection was associated with focal cerebral arteriopathy, supporting the role of infection in childhood stroke.CrossRefPubMed
8.
go back to reference Rea D, Brandsema JF, Armstrong D, et al. Cerebral arteriopathy in children with neurofibromatosis type 1. Pediatrics 2009 (in press). Rea D, Brandsema JF, Armstrong D, et al. Cerebral arteriopathy in children with neurofibromatosis type 1. Pediatrics 2009 (in press).
9.
go back to reference Chabrier S, Rodesch G, Lasjaunias P, et al. Transient cerebral arteriopathy: a disorder recognized by serial angiograms in children with stroke. J Child Neurol 1998;13:27–32.CrossRefPubMed Chabrier S, Rodesch G, Lasjaunias P, et al. Transient cerebral arteriopathy: a disorder recognized by serial angiograms in children with stroke. J Child Neurol 1998;13:27–32.CrossRefPubMed
10.
go back to reference Ganesan V, Chong WK, Cox TC, et al. Posterior circulation stroke in childhood: risk factors and recurrence. Neurology 2002;59:1552–1556.PubMed Ganesan V, Chong WK, Cox TC, et al. Posterior circulation stroke in childhood: risk factors and recurrence. Neurology 2002;59:1552–1556.PubMed
11.
go back to reference Bernard TJ, Goldenberg NA, Tripputi M, et al. Anticoagulation in childhood-onset arterial ischemic stroke with non-moyamoya arteriopathy: findings from the Colorado and German (COAG) collaboration. Stroke 2009;40:2869–2871.CrossRefPubMed Bernard TJ, Goldenberg NA, Tripputi M, et al. Anticoagulation in childhood-onset arterial ischemic stroke with non-moyamoya arteriopathy: findings from the Colorado and German (COAG) collaboration. Stroke 2009;40:2869–2871.CrossRefPubMed
12.
go back to reference Nagel MA, Cohrs RJ, Mahalingam R, et al. The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features. Neurology 2008;70:853–860.CrossRefPubMed Nagel MA, Cohrs RJ, Mahalingam R, et al. The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features. Neurology 2008;70:853–860.CrossRefPubMed
13.
go back to reference Miravet E, Danchaivijitr N, Basu H, et al. Clinical and radiological features of childhood cerebral infarction following varicella zoster virus infection. Dev Med Child Neurol 2007;49:417–422.CrossRefPubMed Miravet E, Danchaivijitr N, Basu H, et al. Clinical and radiological features of childhood cerebral infarction following varicella zoster virus infection. Dev Med Child Neurol 2007;49:417–422.CrossRefPubMed
14.
go back to reference Donahue JG, Kieke BA, Yih WK, et al. Varicella vaccination and ischemic stroke in children: is there an association? Pediatrics 2009;123:e228–e234.CrossRefPubMed Donahue JG, Kieke BA, Yih WK, et al. Varicella vaccination and ischemic stroke in children: is there an association? Pediatrics 2009;123:e228–e234.CrossRefPubMed
15.
go back to reference Ohene-Frempong K, Weiner SJ, Sleeper LA, et al. Cerebrovascular accidents in sickle cell disease: rates and risk factors. Blood 1998;91:288–294.PubMed Ohene-Frempong K, Weiner SJ, Sleeper LA, et al. Cerebrovascular accidents in sickle cell disease: rates and risk factors. Blood 1998;91:288–294.PubMed
16.
go back to reference Adams R, McKie V, Nichols F, et al. The use of transcranial ultrasonography to predict stroke in sickle cell disease. N Engl J Med 1992;326:605–610.PubMedCrossRef Adams R, McKie V, Nichols F, et al. The use of transcranial ultrasonography to predict stroke in sickle cell disease. N Engl J Med 1992;326:605–610.PubMedCrossRef
17.
go back to reference Adams RJ, McKie VC, Hsu L, et al. Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med 1998;339:5–11.CrossRefPubMed Adams RJ, McKie VC, Hsu L, et al. Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med 1998;339:5–11.CrossRefPubMed
18.
go back to reference Mirre E, Brousse V, Berteloot L, et al. Feasibility and efficacy of chronic transfusion for stroke prevention in children with sickle cell disease. Eur J Haematol 2005;84:259–265.CrossRef Mirre E, Brousse V, Berteloot L, et al. Feasibility and efficacy of chronic transfusion for stroke prevention in children with sickle cell disease. Eur J Haematol 2005;84:259–265.CrossRef
19.
go back to reference Colombatti R, Meneghetti G, Ermani M, et al. Primary stroke prevention for sickle cell disease in north-east Italy: the role of ethnic issues in establishing a Transcranial Doppler screening program. Ital J Pediatr 2009;35:15.CrossRefPubMed Colombatti R, Meneghetti G, Ermani M, et al. Primary stroke prevention for sickle cell disease in north-east Italy: the role of ethnic issues in establishing a Transcranial Doppler screening program. Ital J Pediatr 2009;35:15.CrossRefPubMed
20.
go back to reference Armstrong-Wells J, Grimes B, Sidney S, et al. Utilization of TCD screening for primary stroke prevention in children with sickle cell disease. Neurology 2009;72:1316–1321.CrossRefPubMed Armstrong-Wells J, Grimes B, Sidney S, et al. Utilization of TCD screening for primary stroke prevention in children with sickle cell disease. Neurology 2009;72:1316–1321.CrossRefPubMed
21.
go back to reference Dowling MM, Lee N, Quinn CT, et al. Prevalence of intracardiac shunting in children with sickle cell disease and stroke. J Pediatr 2009 (in press). Dowling MM, Lee N, Quinn CT, et al. Prevalence of intracardiac shunting in children with sickle cell disease and stroke. J Pediatr 2009 (in press).
22.
go back to reference •• Roach ES, Golomb MR, Adams R, et al. Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke 2008;39:2644–2691 The American Heart Association Stroke counsel provides a statement of evidence-based recommendations for management of pediatric stroke in various subpopulations of children, including perinatal stroke, childhood arterial ischemic stroke, sickle cell disease, moyamoya disease, cervicocephalic arterial dissection, and cardiogenic embolism. Protocols for dosing of heparin and warfarin in children are suggested.CrossRefPubMed •• Roach ES, Golomb MR, Adams R, et al. Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke 2008;39:2644–2691 The American Heart Association Stroke counsel provides a statement of evidence-based recommendations for management of pediatric stroke in various subpopulations of children, including perinatal stroke, childhood arterial ischemic stroke, sickle cell disease, moyamoya disease, cervicocephalic arterial dissection, and cardiogenic embolism. Protocols for dosing of heparin and warfarin in children are suggested.CrossRefPubMed
23.
go back to reference Chen J, Zimmerman RA, Jarvik GP, et al. Perioperative stroke in infants undergoing open heart operations for congenital heart disease. Ann Thorac Surg 2009;88:823–829.CrossRefPubMed Chen J, Zimmerman RA, Jarvik GP, et al. Perioperative stroke in infants undergoing open heart operations for congenital heart disease. Ann Thorac Surg 2009;88:823–829.CrossRefPubMed
24.
go back to reference Morita DC, Donaldson A, Butterfield RJ, et al. Methylenetetrahydrofolate reductase gene polymorphism and childhood stroke. Pediatr Neurol 2009;41:247–249.CrossRefPubMed Morita DC, Donaldson A, Butterfield RJ, et al. Methylenetetrahydrofolate reductase gene polymorphism and childhood stroke. Pediatr Neurol 2009;41:247–249.CrossRefPubMed
25.
go back to reference Herak DC, Antolic MR, Krleza JL, et al. Inherited prothrombotic risk factors in children with stroke, transient ischemic attack, or migraine. Pediatrics 2009;123:e653–e660.CrossRefPubMed Herak DC, Antolic MR, Krleza JL, et al. Inherited prothrombotic risk factors in children with stroke, transient ischemic attack, or migraine. Pediatrics 2009;123:e653–e660.CrossRefPubMed
26.
go back to reference Zak I, Sarecka-Hujar B, Kopyta I, et al. The T allele of the 677C > T polymorphism of methylenetetrahydrofolate reductase gene is associated with an increased risk of ischemic stroke in Polish children. J Child Neurol 2009;24:1262–1267.CrossRefPubMed Zak I, Sarecka-Hujar B, Kopyta I, et al. The T allele of the 677C > T polymorphism of methylenetetrahydrofolate reductase gene is associated with an increased risk of ischemic stroke in Polish children. J Child Neurol 2009;24:1262–1267.CrossRefPubMed
27.
go back to reference Goldenberg NA, Bernard TJ, Fullerton HJ, et al. Antithrombotic treatments, outcomes, and prognostic factors in acute childhood-onset arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol 2009;8:1120–1127.CrossRefPubMed Goldenberg NA, Bernard TJ, Fullerton HJ, et al. Antithrombotic treatments, outcomes, and prognostic factors in acute childhood-onset arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol 2009;8:1120–1127.CrossRefPubMed
28.
go back to reference •• Monagle P, Chalmers E, Chan A, et al. Antithrombotic therapy in neonates and children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133:887S–968S The American College of Chest Physicians provides clinical practice guidelines for antithrombotic therapy in neonates and children, including guidelines for treatment of acute arterial ischemic stroke with heparin or aspirin.CrossRefPubMed •• Monagle P, Chalmers E, Chan A, et al. Antithrombotic therapy in neonates and children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133:887S–968S The American College of Chest Physicians provides clinical practice guidelines for antithrombotic therapy in neonates and children, including guidelines for treatment of acute arterial ischemic stroke with heparin or aspirin.CrossRefPubMed
29.
go back to reference Amlie-Lefond C, deVeber G, Chan AK, et al. Use of alteplase in childhood arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol 2009;8:530–536.CrossRefPubMed Amlie-Lefond C, deVeber G, Chan AK, et al. Use of alteplase in childhood arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol 2009;8:530–536.CrossRefPubMed
30.
go back to reference Arnold M, Steinlin M, Baumann A, et al. Thrombolysis in childhood stroke: report of 2 cases and review of the literature. Stroke 2009;40:801–807.CrossRefPubMed Arnold M, Steinlin M, Baumann A, et al. Thrombolysis in childhood stroke: report of 2 cases and review of the literature. Stroke 2009;40:801–807.CrossRefPubMed
31.
go back to reference Amlie-Lefond C, Chan AK, Kirton A, et al. Thrombolysis in acute childhood stroke: design and challenges of the thrombolysis in pediatric stroke clinical trial. Neuroepidemiology 2009;32:279–286.CrossRefPubMed Amlie-Lefond C, Chan AK, Kirton A, et al. Thrombolysis in acute childhood stroke: design and challenges of the thrombolysis in pediatric stroke clinical trial. Neuroepidemiology 2009;32:279–286.CrossRefPubMed
32.
go back to reference Srinivasan J, Miller SP, Phan TG, Mackay MT. Delayed recognition of initial stroke in children: need for increased awareness. Pediatrics 2009;124:e227–e234.CrossRefPubMed Srinivasan J, Miller SP, Phan TG, Mackay MT. Delayed recognition of initial stroke in children: need for increased awareness. Pediatrics 2009;124:e227–e234.CrossRefPubMed
33.
go back to reference McGlennan C, Ganesan V. Delays in investigation and management of acute arterial ischaemic stroke in children. Dev Med Child Neurol 2008;50:537–540.CrossRefPubMed McGlennan C, Ganesan V. Delays in investigation and management of acute arterial ischaemic stroke in children. Dev Med Child Neurol 2008;50:537–540.CrossRefPubMed
34.
go back to reference Rafay MF, Pontigon AM, Chiang J, et al. Delay to diagnosis in acute pediatric arterial ischemic stroke. Stroke 2009;40:58–64.CrossRefPubMed Rafay MF, Pontigon AM, Chiang J, et al. Delay to diagnosis in acute pediatric arterial ischemic stroke. Stroke 2009;40:58–64.CrossRefPubMed
35.
go back to reference Hartman AL, Lunney KM, Serena JE. Pediatric stroke: do clinical factors predict delays in presentation? J Pediatr 2009;154:727–732.CrossRefPubMed Hartman AL, Lunney KM, Serena JE. Pediatric stroke: do clinical factors predict delays in presentation? J Pediatr 2009;154:727–732.CrossRefPubMed
36.•
go back to reference Braun KP, Bulder MM, Chabrier S, et al. The course and outcome of unilateral intracranial arteriopathy in 79 children with ischaemic stroke. Brain 2009;132:544–557 The evolution of vascular imaging after childhood arterial ischemic stroke is described in a European cohort. Clinical and imaging characteristics are compared in transient versus progressive cerebral arteriopathies. The majority of children fell under the category of transient cerebral arteriopathy, and recurrent stroke was associated with progressive cerebrovascular disease.CrossRefPubMed Braun KP, Bulder MM, Chabrier S, et al. The course and outcome of unilateral intracranial arteriopathy in 79 children with ischaemic stroke. Brain 2009;132:544–557 The evolution of vascular imaging after childhood arterial ischemic stroke is described in a European cohort. Clinical and imaging characteristics are compared in transient versus progressive cerebral arteriopathies. The majority of children fell under the category of transient cerebral arteriopathy, and recurrent stroke was associated with progressive cerebrovascular disease.CrossRefPubMed
37.
38.
go back to reference Golomb MR, Garg BP, Carvalho KS, et al. Perinatal stroke and the risk of developing childhood epilepsy. J Pediatr 2007;151:409–413, 13e1-2.CrossRefPubMed Golomb MR, Garg BP, Carvalho KS, et al. Perinatal stroke and the risk of developing childhood epilepsy. J Pediatr 2007;151:409–413, 13e1-2.CrossRefPubMed
39.
go back to reference Lee JC, Lin KL, Wang HS, et al. Seizures in childhood ischemic stroke in Taiwan. Brain Dev 2009;31:294–299.CrossRefPubMed Lee JC, Lin KL, Wang HS, et al. Seizures in childhood ischemic stroke in Taiwan. Brain Dev 2009;31:294–299.CrossRefPubMed
40.
go back to reference Everts R, Pavlovic J, Kaufmann F, et al. Cognitive functioning, behavior, and quality of life after stroke in childhood. Child Neuropsychol 2008;14:323–338.CrossRefPubMed Everts R, Pavlovic J, Kaufmann F, et al. Cognitive functioning, behavior, and quality of life after stroke in childhood. Child Neuropsychol 2008;14:323–338.CrossRefPubMed
41.
go back to reference Ricci D, Mercuri E, Barnett A, et al. Cognitive outcome at early school age in term-born children with perinatally acquired middle cerebral artery territory infarction. Stroke 2008;39:403–410.CrossRefPubMed Ricci D, Mercuri E, Barnett A, et al. Cognitive outcome at early school age in term-born children with perinatally acquired middle cerebral artery territory infarction. Stroke 2008;39:403–410.CrossRefPubMed
42.
go back to reference Ballantyne AO, Spilkin AM, Hesselink J, Trauner DA. Plasticity in the developing brain: intellectual, language and academic functions in children with ischaemic perinatal stroke. Brain 2008;131:2975–2985.CrossRefPubMed Ballantyne AO, Spilkin AM, Hesselink J, Trauner DA. Plasticity in the developing brain: intellectual, language and academic functions in children with ischaemic perinatal stroke. Brain 2008;131:2975–2985.CrossRefPubMed
43.
go back to reference Beslow LA, Licht DJ, Smith SE, et al. Predictors of outcome in childhood intracerebral hemorrhage: a prospective consecutive cohort study. Stroke 2009;41:313–318.CrossRefPubMed Beslow LA, Licht DJ, Smith SE, et al. Predictors of outcome in childhood intracerebral hemorrhage: a prospective consecutive cohort study. Stroke 2009;41:313–318.CrossRefPubMed
44.
go back to reference Jordan LC, Kleinman JT, Hillis AE. Intracerebral hemorrhage volume predicts poor neurologic outcome in children. Stroke 2009;40:1666–1671.CrossRefPubMed Jordan LC, Kleinman JT, Hillis AE. Intracerebral hemorrhage volume predicts poor neurologic outcome in children. Stroke 2009;40:1666–1671.CrossRefPubMed
45.
go back to reference Guzzetta A, Pizzardi A, Belmonti V, et al. Hand movements at 3 months predict later hemiplegia in term infants with neonatal cerebral infarction. Dev Med Child Neurol 2009 (in press). Guzzetta A, Pizzardi A, Belmonti V, et al. Hand movements at 3 months predict later hemiplegia in term infants with neonatal cerebral infarction. Dev Med Child Neurol 2009 (in press).
46.
go back to reference Kirton A, Shroff M, Visvanathan T, deVeber G. Quantified corticospinal tract diffusion restriction predicts neonatal stroke outcome. Stroke 2007;38:974–980.CrossRefPubMed Kirton A, Shroff M, Visvanathan T, deVeber G. Quantified corticospinal tract diffusion restriction predicts neonatal stroke outcome. Stroke 2007;38:974–980.CrossRefPubMed
47.
go back to reference Domi T, deVeber G, Shroff M, et al. Corticospinal tract pre-wallerian degeneration: a novel outcome predictor for pediatric stroke on acute MRI. Stroke 2009;40:780–787.CrossRefPubMed Domi T, deVeber G, Shroff M, et al. Corticospinal tract pre-wallerian degeneration: a novel outcome predictor for pediatric stroke on acute MRI. Stroke 2009;40:780–787.CrossRefPubMed
48.
go back to reference Luengo-Fernandez R, Gray AM, Rothwell PM. Costs of stroke using patient-level data: a critical review of the literature. Stroke 2009;40:e18–e23.CrossRefPubMed Luengo-Fernandez R, Gray AM, Rothwell PM. Costs of stroke using patient-level data: a critical review of the literature. Stroke 2009;40:e18–e23.CrossRefPubMed
49.
go back to reference Perkins E, Stephens J, Xiang H, Lo W. The cost of pediatric stroke acute care in the United States. Stroke 2009;40:2820–2827.CrossRefPubMed Perkins E, Stephens J, Xiang H, Lo W. The cost of pediatric stroke acute care in the United States. Stroke 2009;40:2820–2827.CrossRefPubMed
50.
go back to reference Gardner MA, Hills NK, Sidney S, et al. The 5-year direct medical cost of neonatal and childhood stroke in a population-based cohort. Neurology 2009;74:372–378.CrossRef Gardner MA, Hills NK, Sidney S, et al. The 5-year direct medical cost of neonatal and childhood stroke in a population-based cohort. Neurology 2009;74:372–378.CrossRef
Metadata
Title
Recent Advances in Childhood Arterial Ischemic Stroke
Authors
Christine K. Fox
Heather J. Fullerton
Publication date
01-07-2010
Publisher
Current Science Inc.
Published in
Current Atherosclerosis Reports / Issue 4/2010
Print ISSN: 1523-3804
Electronic ISSN: 1534-6242
DOI
https://doi.org/10.1007/s11883-010-0113-8

Other articles of this Issue 4/2010

Current Atherosclerosis Reports 4/2010 Go to the issue