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(Circulation. 2006;114:2094-2095.)
© 2006 American Heart Association, Inc.

Editorial

Arterial Ischemic Stroke in Children

Baby Steps

Alan D. Michelson, MD

From the Center for Platelet Function Studies, Department of Pediatrics, University of Massachusetts Medical School, Worcester, Mass.

Correspondence to Alan D. Michelson, MD, Director, Center for Platelet Function Studies, Professor of Pediatrics, University of Massachusetts Medical School, Room S5–846, 55 Lake Ave North, Worcester, MA 01655. E-mail michelson@platelets.org

Key Words: Editorials • ischemia • stroke • pediatrics • prevention

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Arterial ischemic stroke (AIS) in a child can have devastating, lifelong sequelae.¹ Given the infrequency of AIS (approximately 3 per 100 000 children¹), primary prevention is probably not feasible in the absence of a known risk factor. However, the prevention of recurrent AIS in childhood, ie, secondary prevention, may be feasible. How can recurrent childhood AIS be prevented? Current consensus guidelines on the use of antiplatelet and anticoagulant therapy for AIS in children are not based on randomized controlled trials (RCTs).^2,3 Detailed knowledge of the rates and predictors of AIS recurrence in children is essential before appropriate RCTs can be designed and before rational treatment guidelines can be promulgated. The article by Ganesan et al⁴ in this issue of Circulation provides new information in this regard.

Article p 2170

	Clinically Apparent and Clinically Silent Recurrences After First Childhood AIS

 
Ganesan et al⁴ gathered longitudinal data on the rates of and risk factors for clinical and radiological recurrence of AIS in 212 children at a single large referral center (Great Ormond Street Hospital for Children, London, UK). Acute AIS was defined as an acute focal neurological deficit with evidence of cerebral infarction in an arterial distribution on brain imaging, irrespective of clinical symptoms. Children presenting with hemorrhagic stroke, congenital hemiplegia, or asymptomatic (silent) infarction were excluded. Patients were allocated to 1 of 2 mutually exclusive groups: those with a recognized medical diagnosis before AIS (prior diagnosis group) and those without such a diagnosis (previously healthy group). Patients underwent repeat neuroimaging (magnetic resonance imaging or computerized tomography [CT]) at the time . . . [Full Text of this Article]