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Arterial ischemic stroke in infants, children, and adolescents: results of a Germany-wide surveillance study 2015–2017

Journal of Neurology Aims and scope Submit manuscript

Abstract

Objective

Childhood arterial ischaemic stroke (AIS) is rare, but causes significant morbidity and mortality. We aimed to investigate incidence, age-dependent clinical presentation, and risk factors and to discuss the medical care situation in Germany.

Methods

This prospective epidemiological study was conducted via ESPED (Erhebungseinheit für Seltene Pädiatrische Erkrankungen in Deutschland), a hospital-based German nation-wide surveillance unit for rare pediatric diseases. Children aged 28 days–18 years with first AIS between January 2015 and December 2017 were included.

Results

In the 3-year period, 164 children were reported. Incidence showed peaks in infants, children < 2 years of age, and adolescents (12–18 years), with a significant male predominance observed in adolescents only. Independent of age, most children (91%) presented with focal symptoms, particularly with acute hemiparesis. The occurrence of seizures in infants (57%) and more nonspecific symptoms in school-children and adolescents (54%) is considered noteworthy. Prothrombotic states (34%), cardiac disorders (29%), and arteriopathies (19%) were the most frequently identified risk factors. The majority of children (72/131, thus 55%) were discharged home after acute care phase. At time of discharge, most common neurological symptoms were hemiparesis (42%), facial palsy (15%), and speech disturbance (12%).

Conclusion

This study provides population-based data of childhood AIS which may be useful for further research. The improvement of acute stroke management is needed for children, but also the standardization of post-stroke care in the outpatient setting has to be structured. Considering the higher stroke incidence in (male) adolescents, it is advisable to combine research activities in adolescents and young adults.

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References

  1. Bhogal P, Andersson T, Maus V, Mpotsaris A, Yeo L (2018) Mechanical thrombectomy-a brief review of a revolutionary new treatment for thromboembolic stroke. Clin Neuroradiol. https://doi.org/10.1007/s00062-018-0692-2

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bigi S, Dulcey A, Gralla J, Bernasconi C, Melliger A, Datta AN, Arnold M, Kaesmacher J, Fluss J, Hackenberg A, Maier O, Weber J, Poloni C, Fischer U, Steinlin M (2018) Feasibility, safety, and outcome of recanalization treatment in childhood stroke. Ann Neurol 83(6):1125–1132. https://doi.org/10.1002/ana.25242

    Article  PubMed  Google Scholar 

  3. Bonfert MV, Badura K, Gerstl J, Borggraefe I, Heinen F, Schroeder S, Olivieri M, Weinberger R, Landgraf MN, Vill K, Tacke M, Berweck S, Reiter K, Hoffmann F, Nicolai T, Gerstl L (2018) Childhood stroke: awareness, interest, and knowledge among the pediatric community. Front Pediatr 6:182. https://doi.org/10.3389/fped.2018.00182

    Article  PubMed  PubMed Central  Google Scholar 

  4. Fullerton HJ, Wu YW, Zhao S, Johnston SC (2003) Risk of stroke in children: ethnic and gender disparities. Neurology 61(2):189–194

    Article  Google Scholar 

  5. Gerstl L, Bonfert MV, Nicolai T, Dieterich M, Adamczyk C, Heinen F, Olivieri M, Steinlin M (2017) Childhood stroke: what are the special features of childhood stroke? Nervenarzt 88(12):1367–1376. https://doi.org/10.1007/s00115-017-0435-7

    Article  CAS  PubMed  Google Scholar 

  6. Mackay MT, Yock-Corrales A, Churilov L, Monagle P, Donnan GA, Babl FE (2016) Differentiating childhood stroke from mimics in the Emergency Department. Stroke 47(10):2476–2481. https://doi.org/10.1161/STROKEAHA.116.014179

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mallick AA, Ganesan V, Kirkham FJ, Fallon P, Hedderly T, McShane T, Parker AP, Wassmer E, Wraige E, Amin S, Edwards HB, O'Callaghan FJ (2015) Diagnostic delays in paediatric stroke. J Neurol Neurosurg Psychiatry 86(8):917–921. https://doi.org/10.1136/jnnp-2014-309188

    Article  PubMed  Google Scholar 

  8. Statistisches Bundesamt Deutschland (2019) GENESIS-Online: Bevölkerung: Deutschland, Stichtag, Altersjahre, Nationalität/Geschlecht/Familienstand; Ergebnis—12411-0006. https://www-genesis.destatis.de. Accessed 4 February 2019

  9. Mackay MT, Wiznitzer M, Benedict SL, Lee KJ, Deveber GA, Ganesan V, International Pediatric Stroke Study G (2011) Arterial ischemic stroke risk factors: the international pediatric stroke study. Ann Neurol 69(1):130–140. https://doi.org/10.1002/ana.22224

    Article  PubMed  Google Scholar 

  10. Mallick AA, Ganesan V, Kirkham FJ, Fallon P, Hedderly T, McShane T, Parker AP, Wassmer E, Wraige E, Amin S, Edwards HB, Tilling K, O'Callaghan FJ (2014) Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study. Lancet Neurol 13(1):35–43. https://doi.org/10.1016/S1474-4422(13)70290-4

    Article  PubMed  Google Scholar 

  11. Steinlin M, Pfister I, Pavlovic J, Everts R, Boltshauser E, Capone Mori A, Gubser Mercati D, Hanggeli CA, Keller E, Luetschg J, Marcoz J, Ramelli GP, Roulet Perez E, Schmitt-Mechelke T, Weissert M, Societies Swiss, of Paediatric N, Neonatology, (2005) The first three years of the Swiss Neuropaediatric Stroke Registry (SNPSR): a population-based study of incidence, symptoms and risk factors. Neuropediatrics 36(2):90–97. https://doi.org/10.1055/s-2005-837658

    Article  CAS  PubMed  Google Scholar 

  12. Lehman LL, Beslow LA, Steinlin M, Kossorotoff M, Mackay MT (2019) What will improve pediatric acute stroke care? Stroke 50(2):249–256. https://doi.org/10.1161/STROKEAHA.118.022881

    Article  PubMed  Google Scholar 

  13. Martin C, von Elm E, El-Koussy M, Boltshauser E, Steinlin M, Swiss Neuropediatric Stroke Registry study g (2011) Delayed diagnosis of acute ischemic stroke in children—a registry-based study in Switzerland. Swiss Med Wkly 141:w13281. https://doi.org/10.4414/smw.2011.13281

    Article  PubMed  Google Scholar 

  14. Aroor S, Singh R, Goldstein LB (2017) BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): reducing the proportion of strokes missed using the FAST Mnemonic. Stroke 48(2):479–481. https://doi.org/10.1161/STROKEAHA.116.015169

    Article  PubMed  Google Scholar 

  15. Mackay MT, Chua ZK, Lee M, Yock-Corrales A, Churilov L, Monagle P, Donnan GA, Babl FE (2014) Stroke and nonstroke brain attacks in children. Neurology 82(16):1434–1440. https://doi.org/10.1212/WNL.0000000000000343

    Article  PubMed  Google Scholar 

  16. Mackay MT, Churilov L, Donnan GA, Babl FE, Monagle P (2016) Performance of bedside stroke recognition tools in discriminating childhood stroke from mimics. Neurology 86(23):2154–2161. https://doi.org/10.1212/WNL.0000000000002736

    Article  PubMed  Google Scholar 

  17. Mackay MT, Lee M, Yock-Corrales A, Churilov L, Donnan GA, Monagle P, Babl FE (2018) Differentiating arterial ischaemic stroke from migraine in the paediatric emergency department. Dev Med Child Neurol 60(11):1117–1122. https://doi.org/10.1111/dmcn.13772

    Article  PubMed  Google Scholar 

  18. Mackay MT, Monagle P, Babl FE (2016) Brain attacks and stroke in children. J Paediatr Child Health 52(2):158–163. https://doi.org/10.1111/jpc.13086

    Article  PubMed  Google Scholar 

  19. Neville K, Lo W (2016) Sensitivity and specificity of an adult stroke screening tool in childhood ischemic stroke. Pediatr Neurol 58:53–56. https://doi.org/10.1016/j.pediatrneurol.2016.02.001

    Article  PubMed  Google Scholar 

  20. Yock-Corrales A, Babl FE, Mosley IT, Mackay MT (2011) Can the FAST and ROSIER adult stroke recognition tools be applied to confirmed childhood arterial ischemic stroke? BMC Pediatr 11:93. https://doi.org/10.1186/1471-2431-11-93

    Article  PubMed  PubMed Central  Google Scholar 

  21. Yock-Corrales A, Varela-Bulgarelli F, Barboza C, Gutierrez-Mata A, Mackay MT, Babl F (2016) Presentation of acute childhood stroke in a Tertiary Pediatric Emergency Department. Pediatr Emerg Care. https://doi.org/10.1097/PEC.0000000000000918

    Article  Google Scholar 

  22. Bulder MM, Hellmann PM, van Nieuwenhuizen O, Kappelle LJ, Klijn CJ, Braun KP (2011) Measuring outcome after arterial ischemic stroke in childhood with two different instruments. Cerebrovasc Dis 32(5):463–470. https://doi.org/10.1159/000332087

    Article  CAS  PubMed  Google Scholar 

  23. Cooper AN, Anderson V, Hearps S, Greenham M, Hunt RW, Mackay MT, Monagle P, Gordon AL (2018) The Pediatric stroke outcome measure: a predictor of outcome following arterial ischemic stroke. Neurology 90(5):e365–e372. https://doi.org/10.1212/WNL.0000000000004906

    Article  PubMed  Google Scholar 

  24. Ichord RN, Bastian R, Abraham L, Askalan R, Benedict S, Bernard TJ, Beslow L, Deveber G, Dowling M, Friedman N, Fullerton H, Jordan L, Kan L, Kirton A, Amlie-Lefond C, Licht D, Lo W, McClure C, Pavlakis S, Smith SE, Tan M, Kasner S, Jawad AF (2011) Interrater reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a multicenter study. Stroke 42(3):613–617. https://doi.org/10.1161/STROKEAHA.110.607192

    Article  PubMed  PubMed Central  Google Scholar 

  25. Chan AK, deVeber G (2000) Prothrombotic disorders and ischemic stroke in children. Semin Pediatr Neurol 7(4):301–308

    Article  CAS  Google Scholar 

  26. Deng Y, Wang Y, Yang W, Yu Y, Xu J, Wang Y, Gao B (2015) Risk factors and imaging characteristics of childhood stroke in china. J Child Neurol 30(3):339–343. https://doi.org/10.1177/0883073814538667

    Article  PubMed  Google Scholar 

  27. Zadro R, Herak DC (2012) Inherited prothrombotic risk factors in children with first ischemic stroke. Biochem Med 22(3):298–310

    Article  CAS  Google Scholar 

  28. Amlie-Lefond C, Bernard TJ, Sebire G, Friedman NR, Heyer GL, Lerner NB, DeVeber G, Fullerton HJ, International Pediatric Stroke Study G (2009) Predictors of cerebral arteriopathy in children with arterial ischemic stroke: results of the international pediatric stroke study. Circulation 119(10):1417–1423. https://doi.org/10.1161/CIRCULATIONAHA.108.806307

    Article  PubMed  PubMed Central  Google Scholar 

  29. Braun KP, Bulder MM, Chabrier S, Kirkham FJ, Uiterwaal CS, Tardieu M, Sebire G (2009) The course and outcome of unilateral intracranial arteriopathy in 79 children with ischaemic stroke. Brain 132(Pt 2):544–557. https://doi.org/10.1093/brain/awn313

    Article  CAS  PubMed  Google Scholar 

  30. Kirton A, deVeber G (2015) Paediatric stroke: pressing issues and promising directions. Lancet Neurol 14(1):92–102. https://doi.org/10.1016/S1474-4422(14)70227-3

    Article  PubMed  Google Scholar 

  31. Wintermark M, Hills NK, deVeber GA, Barkovich AJ, Elkind MS, Sear K, Zhu G, Leiva-Salinas C, Hou Q, Dowling MM, Bernard TJ, Friedman NR, Ichord RN, Fullerton HJ, Investigators V (2014) Arteriopathy diagnosis in childhood arterial ischemic stroke: results of the vascular effects of infection in pediatric stroke study. Stroke 45(12):3597–3605. https://doi.org/10.1161/STROKEAHA.114.007404

    Article  PubMed  PubMed Central  Google Scholar 

  32. Steinlin M, Bigi S, Stojanovski B, Gajera J, Regenyi M, El-Koussy M, Mackay MT (2017) Focal cerebral arteriopathy: do steroids improve outcome? Stroke. https://doi.org/10.1161/STROKEAHA.117.016818

    Article  PubMed  Google Scholar 

  33. Yeon JY, Shin HJ, Seol HJ, Kim JS, Hong SC (2014) Unilateral intracranial arteriopathy in pediatric stroke: course, outcome, and prediction of reversible arteriopathy. Stroke 45(4):1173–1176. https://doi.org/10.1161/STROKEAHA.113.004125

    Article  PubMed  Google Scholar 

  34. Kottoor SJ, Arora RR (2018) Cryptogenic stroke: to close a patent Foramen Ovale or not to close? J Cent Nerv Syst Dis 10:1179573518819476. https://doi.org/10.1177/1179573518819476

    Article  PubMed  PubMed Central  Google Scholar 

  35. Khan R, Chan AK, Mondal TK, Paes BA, Thrombosis Hemostasis in Newborns G (2016) Patent foramen ovale and stroke in childhood: a systematic review of the literature. Eur J Paediatr Neurol 20(4):500–511. https://doi.org/10.1016/j.ejpn.2016.04.012

    Article  PubMed  Google Scholar 

  36. Sultan S, Dowling M, Kirton A, DeVeber G, Linds A, Elkind MSV, Investigators I (2018) Dyslipidemia in children with arterial ischemic stroke: prevalence and risk factors. Pediatr Neurol 78:46–54. https://doi.org/10.1016/j.pediatrneurol.2017.09.019

    Article  PubMed  Google Scholar 

  37. Sultan SM, Schupf N, Dowling MM, Deveber GA, Kirton A, Elkind MS (2014) Review of lipid and lipoprotein(a) abnormalities in childhood arterial ischemic stroke. Int J Stroke 9(1):79–87. https://doi.org/10.1111/ijs.12136

    Article  PubMed  Google Scholar 

  38. Willeit P, Kiechl S, Kronenberg F, Witztum JL, Santer P, Mayr M, Xu Q, Mayr A, Willeit J, Tsimikas S (2014) Discrimination and net reclassification of cardiovascular risk with lipoprotein(a): prospective 15-year outcomes in the Bruneck Study. J Am Coll Cardiol 64(9):851–860. https://doi.org/10.1016/j.jacc.2014.03.061

    Article  PubMed  Google Scholar 

  39. deVeber G, Kirkham F, Shannon K, Brandao L, Strater R, Kenet G, Clausnizer H, Moharir M, Kausch M, Askalan R, MacGregor D, Stoll M, Torge A, Dlamini N, Ganesan V, Prengler M, Singh J, Nowak-Gottl U (2019) Recurrent stroke: the role of thrombophilia in a large international pediatric stroke population. Haematologica. https://doi.org/10.3324/haematol.2018.211433

    Article  PubMed  PubMed Central  Google Scholar 

  40. Goldenberg NA, Bernard TJ, Hillhouse J, Armstrong-Wells J, Galinkin J, Knapp-Clevenger R, Jacobson L, Marcovina SM, Manco-Johnson MJ (2013) Elevated lipoprotein (a), small apolipoprotein (a), and the risk of arterial ischemic stroke in North American children. Haematologica 98(5):802–807. https://doi.org/10.3324/haematol.2012.073833

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. 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(11):3678–3682

    Article  CAS  Google Scholar 

  42. Strater R, Becker S, von Eckardstein A, Heinecke A, Gutsche S, Junker R, Kurnik K, Schobess R, Nowak-Gottl U (2002) Prospective assessment of risk factors for recurrent stroke during childhood–a 5-year follow-up study. Lancet 360(9345):1540–1545. https://doi.org/10.1016/S0140-6736(02)11520-0

    Article  PubMed  Google Scholar 

  43. Androulakis XM, Kodumuri N, Giamberardino LD, Rosamond WD, Gottesman RF, Yim E, Sen S (2016) Ischemic stroke subtypes and migraine with visual aura in the ARIC study. Neurology 87(24):2527–2532. https://doi.org/10.1212/WNL.0000000000003428

    Article  PubMed  PubMed Central  Google Scholar 

  44. Gelfand AA, Fullerton HJ, Jacobson A, Sidney S, Goadsby PJ, Kurth T, Pressman A (2015) Is migraine a risk factor for pediatric stroke? Cephalalgia 35(14):1252–1260. https://doi.org/10.1177/0333102415576222

    Article  PubMed  PubMed Central  Google Scholar 

  45. Schurks M, Rist PM, Bigal ME, Buring JE, Lipton RB, Kurth T (2009) Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ 339:b3914. https://doi.org/10.1136/bmj.b3914

    Article  PubMed  PubMed Central  Google Scholar 

  46. Sen S, Androulakis XM, Duda V, Alonso A, Chen LY, Soliman EZ, Magnani J, Trivedi T, Merchant AT, Gottesman RF, Rosamond WD (2018) Migraine with visual aura is a risk factor for incident atrial fibrillation: a cohort study. Neurology 91(24):e2202–e2210. https://doi.org/10.1212/WNL.0000000000006650

    Article  PubMed  PubMed Central  Google Scholar 

  47. Elkind MS, Hills NK, Glaser CA, Lo WD, Amlie-Lefond C, Dlamini N, Kneen R, Hod EA, Wintermark M, deVeber GA, Fullerton HJ, Investigators* V, (2016) herpesvirus infections and childhood arterial ischemic stroke: results of the VIPS study. Circulation 133(8):732–741. https://doi.org/10.1161/CIRCULATIONAHA.115.018595

    Article  PubMed  PubMed Central  Google Scholar 

  48. Fullerton HJ, Hills NK, Elkind MS, Dowling MM, Wintermark M, Glaser CA, Tan M, Rivkin MJ, Titomanlio L, Barkovich AJ, deVeber GA, Investigators V (2015) Infection, vaccination, and childhood arterial ischemic stroke: results of the VIPS study. Neurology 85(17):1459–1466. https://doi.org/10.1212/WNL.0000000000002065

    Article  PubMed  PubMed Central  Google Scholar 

  49. Fullerton HJ, Luna JM, Wintermark M, Hills NK, Tokarz R, Li Y, Glaser C, DeVeber GA, Lipkin WI, Elkind MSV, Investigators* V, (2017) Parvovirus B19 infection in children with arterial ischemic stroke. Stroke 48(10):2875–2877. https://doi.org/10.1161/STROKEAHA.117.018272

    Article  PubMed  PubMed Central  Google Scholar 

  50. Czlonkowska A, Ciesielska A, Gromadzka G, Kurkowska-Jastrzebska I (2006) Gender differences in neurological disease: role of estrogens and cytokines. Endocrine 29(2):243–256. https://doi.org/10.1385/ENDO:29:2:243

    Article  CAS  PubMed  Google Scholar 

  51. Golomb MR, Fullerton HJ, Nowak-Gottl U, Deveber G, International Pediatric Stroke Study G (2009) Male predominance in childhood ischemic stroke: findings from the international pediatric stroke study. Stroke 40(1):52–57. https://doi.org/10.1161/STROKEAHA.108.521203

    Article  PubMed  Google Scholar 

  52. Normann S, de Veber G, Fobker M, Langer C, Kenet G, Bernard TJ, Fiedler B, Strater R, Goldenberg NA, Nowak-Gottl U (2009) Role of endogenous testosterone concentration in pediatric stroke. Ann Neurol 66(6):754–758. https://doi.org/10.1002/ana.21840

    Article  CAS  PubMed  Google Scholar 

  53. Stack CA, Cole JW (2018) Ischemic stroke in young adults. Curr Opin Cardiol 33(6):594–604. https://doi.org/10.1097/HCO.0000000000000564

    Article  PubMed  Google Scholar 

  54. Kivioja R, Pietila A, Martinez-Majander N, Gordin D, Havulinna AS, Salomaa V, Aarnio K, Curtze S, Leiviska J, Rodriguez-Pardo J, Surakka I, Kaste M, Tatlisumak T, Putaala J (2018) Risk factors for early-onset ischemic stroke: a case-control study. J Am Heart Assoc 7(21):e009774. https://doi.org/10.1161/JAHA.118.009774

    Article  PubMed  PubMed Central  Google Scholar 

  55. Aigner A, Grittner U, Rolfs A, Norrving B, Siegerink B, Busch MA (2017) Contribution of established stroke risk factors to the burden of stroke in young adults. Stroke 48(7):1744–1751. https://doi.org/10.1161/STROKEAHA.117.016599

    Article  PubMed  Google Scholar 

  56. Bhatt N, Malik AM, Chaturvedi S (2018) Stroke in young adults: five new things. Neurol Clin Pract 8(6):501–506. https://doi.org/10.1212/CPJ.0000000000000522

    Article  PubMed  Google Scholar 

  57. van Alebeek ME, Arntz RM, Ekker MS, Synhaeve NE, Maaijwee NA, Schoonderwaldt H, van der Vlugt MJ, van Dijk EJ, Rutten-Jacobs LC, de Leeuw FE (2018) Risk factors and mechanisms of stroke in young adults: the FUTURE study. J Cereb Blood Flow Metab 38(9):1631–1641. https://doi.org/10.1177/0271678X17707138

    Article  PubMed  Google Scholar 

  58. Ferriero DM, Fullerton HJ, Bernard TJ, Billinghurst L, Daniels SR, DeBaun MR, deVeber G, Ichord RN, Jordan LC, Massicotte P, Meldau J, Roach ES, Smith ER, American Heart Association Stroke C, Council on C, Stroke N (2019) Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke. https://doi.org/10.1161/STR.0000000000000183

  59. Medley TL, Miteff C, Andrews I, Ware T, Cheung M, Monagle P, Mandelstam S, Wray A, Pridmore C, Troedson C, Dale RC, Fahey M, Sinclair A, Walsh P, Stojanovski B, Mackay MT (2018) Australian Clinical Consensus Guideline: The diagnosis and acute management of childhood stroke. Int J Stroke. https://doi.org/10.1177/1747493018799958

    Article  Google Scholar 

  60. Barlinn J, Barlinn K, Helbig U, Siepmann T, Pallesen LP, Urban H, Putz V, Schmitt J, Reichmann H, Bodechtel U (2016) Organized post-stroke care through case management on the basis of a standardized treatment pathway : results of a single-centre pilot study. Nervenarzt 87(8):860–869. https://doi.org/10.1007/s00115-016-0100-6

    Article  CAS  PubMed  Google Scholar 

  61. Bodechtel U, Barlinn K, Helbig U, Arnold K, Siepmann T, Pallesen LP, Puetz V, Reichmann H, Schmitt J, Kepplinger J (2016) The stroke east Saxony pilot project for organized post-stroke care: a case-control study. Brain Behav 6(5):e00455. https://doi.org/10.1002/brb3.455

    Article  PubMed  PubMed Central  Google Scholar 

  62. Lynch JK, Hirtz DG, DeVeber G, Nelson KB (2002) Report of the National Institute of Neurological Disorders and Stroke workshop on perinatal and childhood stroke. Pediatrics 109(1):116–123

    Article  Google Scholar 

  63. Bundesamt für gesundheitliche Aufklärung (2019) Welches Krankenhaus ist das Richtige? https://www.kindergesundheit-info.de/themen/krankes-kind/im-krankheitsfall/krankenhaus10/. Accessed 18 Mar 2019

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Acknowledgements

The authors thank all pediatricians reporting to ESPED.

Funding

Building up the database was financially supported by Friedrich-Baur-Stiftung, München.

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Authors and Affiliations

  1. Department of Pediatric Neurology and Developmental Medicine, LMU Munich, University Hospital, Dr. von Hauner Children`s Hospital, Lindwurmstr. 4, 80337, Munich, Germany

    Lucia Gerstl, Florian Heinen, Michaela V. Bonfert, Ingo Borggraefe, A. Sebastian Schroeder, Moritz Tacke, Mirjam N. Landgraf & Katharina Vill

  2. Division of Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, LMU Munich, Lindwurmstr. 4, 80337, Munich, Germany

    Raphael Weinberger & Anna-Lisa Sorg

  3. Department of Pediatric Hemostasis and Thrombosis, LMU Munich, University Hospital, Dr. von Hauner Children`s Hospital, Lindwurmstr. 4, 80337, Munich, Germany

    Karin Kurnik & Martin Olivieri

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  1. Lucia Gerstl
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Correspondence to Lucia Gerstl.

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Ethical standards statement

The study was approved by the ethics committee of the Medical Faculty of the Ludwig-Maximilians-University Munich, Number 42-15 (05-04-2015) and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Gerstl, L., Weinberger, R., Heinen, F. et al. Arterial ischemic stroke in infants, children, and adolescents: results of a Germany-wide surveillance study 2015–2017. J Neurol 266, 2929–2941 (2019). https://doi.org/10.1007/s00415-019-09508-5

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