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European Journal of Pediatrics

, Volume 169, Issue 5, pp 557–562 | Cite as

Athletics, minor trauma, and pediatric arterial ischemic stroke

  • Kathryn Sepelyak
  • Philippe Gailloud
  • Lori C. JordanEmail author
Original Paper

Abstract

Pediatric arterial ischemic stroke may occur as the result of trivial head or neck trauma sustained during a sports activity. We describe three cases of sports-related stroke in previously healthy school-age children and discuss acute and long-term stroke care. Possible mechanisms of sports-related stroke are addressed, as is evaluation for cause of stroke in children. In one of the reported cases, the child was found to have a vertebral artery dissection as the cause of his stroke, but no definitive cause of stroke was identified in the other two cases despite extensive evaluation. The advisability and timing of returning to athletic activities after stroke is also discussed. Many children with sports-related stroke are initially seen by a sports trainer, a pediatrician, or an ER physician. Thus, it is particularly important that these professionals are aware of the possibility of ischemic stroke occurring after even mild athletic injury. Childhood stroke may result from injuries sustained during athletic activities and should be considered when a child has acute focal neurologic signs.

Keywords

Pediatric stroke Sports-related stroke Athletic injury Arterial dissection 

Notes

Funding source

Lori Jordan was supported by the National Institute of Neurologic Disorders and Stroke K23NS062110.

Conflicts of interest

The authors have no conflicts of interest to disclose.

References

  1. 1.
    Arauz A, Hoyos L, Espinoza C, Cantu C, Barinagarrementeria F, Roman G (2006) Dissection of cervical arteries: long-term follow-up study of 130 consecutive cases. Cerebrovasc Dis 22:150–154CrossRefPubMedGoogle Scholar
  2. 2.
    Bernard TJ, deVeber GA, Benke TA (2007) Athletic participation after acute ischemic childhood stroke: a survey of pediatric stroke experts. J Child Neurol 22:1050–1053CrossRefPubMedGoogle Scholar
  3. 3.
    Bernard TJ, Goldenberg NA (2008) Pediatric arterial ischemic stroke. Pediatr Clin North Am 55:323–338CrossRefPubMedGoogle Scholar
  4. 4.
    Braun KP, Kappelle LJ, Kirkham FJ, Deveber G (2006) Diagnostic pitfalls in paediatric ischaemic stroke. Dev Med Child Neurol 48:985–990CrossRefPubMedGoogle Scholar
  5. 5.
    Burger IM, Murphy KJ, Jordan LC, Tamargo RJ, Gailloud P (2006) Safety of cerebral digital subtraction angiography in children: complication rate analysis in 241 consecutive diagnostic angiograms. Stroke 37:2535–2539CrossRefPubMedGoogle Scholar
  6. 6.
    Caplan LR (2008) Dissections of brain-supplying arteries. Nat Clin Pract Neurol 4:34–42CrossRefPubMedGoogle Scholar
  7. 7.
    Dittrich R, Rohsbach D, Heidbreder A et al (2007) Mild mechanical traumas are possible risk factors for cervical artery dissection. Cerebrovasc Dis 23:275–281CrossRefPubMedGoogle Scholar
  8. 8.
    Flis CM, Jager HR, Sidhu PS (2007) Carotid and vertebral artery dissections: clinical aspects, imaging features and endovascular treatment. Eur Radiol 17:820–834CrossRefPubMedGoogle Scholar
  9. 9.
    Fullerton HJ, Johnston SC, Smith WS (2001) Arterial dissection and stroke in children. Neurology 57:1155–1160PubMedGoogle Scholar
  10. 10.
    Fullerton HJ, Wu YW, Zhao S, Johnston SC (2003) Risk of stroke in children: ethnic and gender disparities. Neurology 61:189–194PubMedGoogle Scholar
  11. 11.
    Gabis LV, Yangala R, Lenn NJ (2002) Time lag to diagnosis of stroke in children. Pediatrics 110:924–928CrossRefPubMedGoogle Scholar
  12. 12.
    Kieslich M, Fiedler A, Heller C et al (2002) Minor head injury as cause and co-factor in the aetiology of stroke in childhood: a report of eight cases. J Neurol Neurosurg Psychiatry 73:13–16CrossRefPubMedGoogle Scholar
  13. 13.
    Lynch JK, Pavlakis S, Deveber G (2005) Treatment and prevention of cerebrovascular disorders in children. Curr Treat Options Neurol 7:469–4802CrossRefPubMedGoogle Scholar
  14. 14.
    Miller PR, Fabian TC, Croce MA et al (2002) Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes. Ann Surg 236:386–393CrossRefPubMedGoogle Scholar
  15. 15.
    Pettersson H, Fitz CR, Harwood-Nash DC, Chuang S, Armstrong E (1981) Iatrogenic embolization: complication of pediatric cerebral angiography. AJNR Am J Neuroradiol 2:357–361PubMedGoogle Scholar
  16. 16.
    Rafay MF, Pontigon AM, Chiang J, Adams M, Jarvis DA, Silver F, Macgregor D, Deveber GA (2009) Delay to diagnosis in acute pediatric arterial ischemic stroke. Stroke 40:58–64CrossRefPubMedGoogle Scholar
  17. 17.
    Roach ES, Golomb MR, Adams R, Biller J, Daniels S, Deveber G, Ferriero D, Jones BV, Kirkham FJ, Scott RM, Smith ER, American Heart Association Stroke Council, Council on Cardiovascular Disease in the Young (2008) 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 39:2644–2691CrossRefPubMedGoogle Scholar
  18. 18.
    Schievink WI (2001) Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 344:898–906CrossRefPubMedGoogle Scholar
  19. 19.
    Shaffer L, Rich PM, Pohl KR, Ganesan V (2003) Can mild head injury cause ischaemic stroke? Arch Dis Child 88:267–269CrossRefPubMedGoogle Scholar
  20. 20.
    Vertinsky AT, Schwartz NE, Fischbein NJ, Rosenberg J, Albers GW, Zaharchuk G (2008) Comparison of multidetector CT angiography and MR imaging of cervical artery dissection. AJNR Am J Neuroradiol 29:1753–1760CrossRefPubMedGoogle Scholar
  21. 21.
    Willinsky RA, Taylor SM, TerBrugge K, Farb RI, Tomlinson G, Montanera W (2003) Neurologic complications of cerebral angiography: prospective analysis of 2, 899 procedures and review of the literature. Radiology 227:522–528CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Kathryn Sepelyak
    • 1
  • Philippe Gailloud
    • 2
  • Lori C. Jordan
    • 1
    • 3
    Email author
  1. 1.Department of NeurologyJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of RadiologyJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of PediatricsJohns Hopkins University School of MedicineBaltimoreUSA

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