This Article Full Text Full Text (PDF) Data Supplement All Versions of this Article: 119/10/1417    most recent CIRCULATIONAHA.108.806307v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Amlie-Lefond, C. Search for Related Content PubMed PubMed Citation Articles by Amlie-Lefond, C. Related Collections Acute Cerebral Hemorrhage Risk Factors for Stroke Stroke in Children and the Young Related Article

(Circulation. 2009;119:1417-1423.)
© 2009 American Heart Association, Inc.

Stroke

Predictors of Cerebral Arteriopathy in Children With Arterial Ischemic Stroke

Results of the International Pediatric Stroke Study

Catherine Amlie-Lefond, MD; Timothy J. Bernard, MD; Guillaume Sébire, MD, PhD; Neil R. Friedman, MBChB; Geoffrey L. Heyer, MD; Norma B. Lerner, MD, MPH; Gabrielle deVeber, MD, MSc; Heather J. Fullerton, MD, MAS, for the International Pediatric Stroke Study Group

From the Department of Neurology, Medical College of Wisconsin and Children’s Hospital of Wisconsin, Milwaukee (C.A.-L.); Department of Pediatrics, Section of Pediatric Neurology, University of Colorado and Children’s Hospital, Denver (T.J.B.); Service de Neuropediatrie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada (G.S.); Center for Pediatric Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio (N.R.F.); Department of Pediatrics, Section of Pediatric Neurology, Nationwide Children’s Hospital, Columbus, Ohio (G.L.H.); Department of Pediatrics, Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (N.B.L.); Department of Neurology, Hospital for Sick Children, Toronto, Ontario (G.d.V.); and Departments of Neurology and Pediatrics, University of California, San Francisco (H.J.F.).

Correspondence to Heather J. Fullerton, MD, MAS, University of California, San Francisco, Department of Neurology, Box 0114, 505 Parnassus Ave, San Francisco, CA 94143–0114. E-mail fullertonh{at}neuropeds.ucsf.edu

Received July 10, 2008; accepted October 10, 2008.

Background— Cerebral arteriopathies, including an idiopathic focal cerebral arteriopathy of childhood (FCA), are common in children with arterial ischemic stroke and strongly predictive of recurrence. To better understand these lesions, we measured predictors of arteriopathy within a large international series of children with arterial ischemic stroke.

Methods and Results— Between January 2003 and July 2007, 30 centers within the International Pediatric Stroke Study enrolled 667 children (age, 29 days to 19 years) with arterial ischemic stroke and abstracted clinical and radiographic data. Cerebral arteriopathy and its subtypes were defined using published definitions; FCA was defined as cerebral arterial stenosis not attributed to specific diagnoses such as moyamoya, arterial dissection, vasculitis, or postvaricella angiopathy. We used multivariate logistic regression techniques to determine predictors of arteriopathy and FCA among those subjects who received vascular imaging. Of 667 subjects, 525 had known vascular imaging results, and 53% of those (n=277) had an arteriopathy. The most common arteriopathies were FCA (n=69, 25%), moyamoya (n=61, 22%), and arterial dissection (n=56, 20%). Predictors of arteriopathy include early school age (5 to 9 years), recent upper respiratory infections, and sickle cell disease, whereas prior cardiac disease and sepsis reduced the risk of arteriopathy. The only predictor of FCA was recent upper respiratory infection.

Conclusions— Arteriopathy is prevalent among children with arterial ischemic stroke, particularly those presenting in early school age, and those with a history of sickle cell disease. Recent upper respiratory infection predicted cerebral arteriopathy and FCA in particular, suggesting a possible role for infection in the pathogenesis of these lesions.

---

 

CLINICAL PERSPECTIVE

Related Article:

Clinical Summaries
Circulation 2009 119: 1353-1354. [Extract] [Full Text]

This article has been cited by other articles:

				M. P. Massicotte and J. Y. Yager Stroke in Children: First Steps on the Road to Intervention Circulation, March 17, 2009; 119(10): 1361 - 1362. [Full Text] [PDF]