Pediatric stroke: the importance of cerebral arteriopathy and vascular malformations
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Population-based estimates of the annual incidence of childhood stroke range from 2 to 13 per 100,000 person-years. More than half of children who have had a stroke have long-term neurological sequelae. The goal of this article is to review recent literature on both hemorrhagic and ischemic stroke in children with a focus on cerebral arteriopathy and vascular malformations as stroke risk factors. Additionally, we review diagnostic studies for childhood stroke, outcome data, and regional and geographic practice differences.
PubMed was searched using the terms child, childhood, pediatric, stroke, ischemic, intracerebral hemorrhage, vasculopathy, and vascular malformation. Reference lists of these articles were reviewed for additional key publications. Preference was given to articles published since the year 2000; however, seminal articles in the field were also reviewed.
Pediatric stroke is a heterogeneous disorder and a major cause of morbidity in the pediatric population. Five-year recurrence risk is estimated to be 5–19%. Children with cerebrovascular abnormalities are at the highest risk of recurrence (66% at 5 years for ischemic stroke in one study). Furthermore, cerebral arteriopathy including arterial dissection may account for up to 80% of childhood stroke in otherwise healthy children.
In many cases, evaluation and treatment of pediatric stroke is not evidence-based, and regional and geographic variations in practice patterns exist. Ultimately multicenter cohort studies and dedicated pediatric clinical trials are essential to establish comprehensive evidence-based guidelines for pediatric stroke care.
KeywordsStroke Child Pediatric stroke Arteriopathy Vascular malformation Review
- 1.Heideman RL, Packer RJ, Albright LA, Freeman CR, Rorke LB (1997) Tumors of the central nervous system. In: Pizzo PA (ed) Principles and practice of pediatric oncology, 3rd edn. Lippencott, Philadelphia, pp 633–697Google Scholar
- 2.National Center for Health Statistics (2002) Deaths, percentage of total deaths, and death rates for the 10 leading causes of death in selected age groups, by race and sex: United States. www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_17.pdf. Updated 2005. Accessed 16 June 2006
- 5.Goldenberg NA, Bernard TJ, Fullerton HJ, Gordon A, Deveber G, for the International Pediatric Stroke Study Group (2009) Antithrombotic treatments, outcomes, and prognostic factors in acute childhood-onset arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol 8(12):1120–1127CrossRefPubMedGoogle Scholar
- 18.Nowak-Gottl U, Strater R, Heinecke A, Junker R, Koch HG, Schuierer G, von Eckardstein A (1999) Lipoprotein (a) and genetic polymorphisms of clotting factor V, prothrombin, and methylenetetrahydrofolate reductase are risk factors of spontaneous ischemic stroke in childhood. Blood 94:3678–3682PubMedGoogle Scholar
- 21.Miller ST, Macklin EA, Pegelow CH, Kinney T, Sleeper L, Bello J, DeWitt D, Gallagher D, Guarini L, Moser F, Ohene-Frempong K, Sanchez N, Vichinsky E, Wang W, Wethers D, Younkin D, Zimmerman R, DeBaun R, Cooperative Study of Sickle Cell Disease (2001) Silent infarction as a risk factor for overt stroke in children with sickle cell anemia: a report from the cooperative study of sickle cell disease. J Pediatr 139:385–390CrossRefPubMedGoogle Scholar
- 33.Roach ES, Golomb MR, Adams R, Biller J, Daniels S, deVeber G, Ferriero D, Jones B, Kirkham F, Scott M, Smith E (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
- 34.Benseler SM, deVeber G, Hawkins C, Schneider R, Tyrrell P, Aviv R, Armstrong D, Laxer R, Silverman E (2005) Angiography-negative primary central nervous system vasculitis in children: a newly recognized inflammatory central nervous system disease. Arthritis Rheum 52:2159–2167CrossRefPubMedGoogle Scholar
- 45.Pediatric Stroke Working Group (2004) Stroke in childhood: clinical guidelines for diagnosis, management and rehabilitation. http://www.rcplondon.ac.uk/pubs/books/stroke/stroke_guidelines_2ed.pdf. Accessed 26 October 2009
- 48.Broderick JP, Adams HP Jr, Barsan W, Feinberg W, Feldmann E, Grotta J, Kase C, Krieger D, Mayberg M, Tilley B, Zabramski J, Zuccarello M (1999) Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 30:905–915PubMedGoogle Scholar
- 57.The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587Google Scholar
- 58.Del Zoppo GJ, Saver JL, Jauch EC, Adams HP Jr, American Heart Association Stroke Council (2009) Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: a science advisory from the American Heart Association/American Stroke Association. Stroke 40:2945–2948CrossRefPubMedGoogle Scholar
- 65.Amlie-Lefond C, Deveber G, Chan AK, Benedict S, Bernard T, Carpenter J, Dowling M, Fullerton H, Hovinga C, Kirton A, Lo W, Zamel K, Ichord R (2009) Use of alteplase in childhood arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol 8:530–536CrossRefPubMedGoogle Scholar
- 68.Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, Amelink GJ, Schmiedeck P, Schwab S, Rothwell P, Bousser MG, van der Worp HB, Hacke W, Decimal, Destiny and Hamlet investigators (2007) Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 6:215–222CrossRefPubMedGoogle Scholar
- 69.Mendelow AD, Gregson BA, Fernandes HM, Murray G, Teasdale G, Hope DT, Karimi A, Shaw MDM, Barer D, Stich investigators (2005) Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the international surgical trial in intracerebral haemorrhage (STICH): a randomised trial. Lancet 365:387–397PubMedGoogle Scholar
- 85.Manco-Johnson MJ, Grabowski EF, Hellgreen M, Kemahli AS, Massicotte MP, Muntean W, Peters M, Nowak-Göttl U (2002) Laboratory testing for thrombophilia in pediatric patients. On behalf of the Subcommittee for Perinatal and Pediatric Thrombosis of the Scientific and Standardization Committee of the International Society of Thrombosis and Haemostasis (ISTH). Thromb Haemost 88:155–156PubMedGoogle Scholar
- 86.Kenet G, Lütkhoff LK, Albisetti M, Bernard T, Bonduel M, Brandao L, Chabrier S, Chan A, deVeber G, Fiedler B, Fullerton HJ, Goldenberg NA, Grabowski E, Günther G, Heller C, Holzhauer S, Iorio A, Journeycake J, Junker R, Kirkham FJ, Kurnik K, Lynch JK, Male C, Manco-Johnson M, Mesters R, Monagle P, van Ommen CH, Raffini L, Rostásy K, Simioni P, Sträter RD, Young G, Nowak-Göttl U (2010) Impact of thrombophilia on risk of arterial ischemic stroke or cerebral sinovenous thrombosis in neonates and children: a systematic review and meta-analysis of observational studies. Circulation 121:1838–1847Google Scholar