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Pediatric stroke: the importance of cerebral arteriopathy and vascular malformations

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgments

Lauren Beslow is supported by the National Institutes of Health T32NS007413 and by the L. Morton Morley Funds of the Philadelphia Foundation.

Lori Jordan is supported by the National Institutes of Health K23NS062110.

Conflict of interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Division of Neurology, The Children’s Hospital of Philadelphia, Colket Translational Research Building, 3501 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Lauren A. Beslow

  2. Department of Neurology, Division of Pediatric Neurology, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Suite 2158, Baltimore, MD, 21287, USA

    Lori C. Jordan

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Beslow, L.A., Jordan, L.C. Pediatric stroke: the importance of cerebral arteriopathy and vascular malformations. Childs Nerv Syst 26, 1263–1273 (2010). https://doi.org/10.1007/s00381-010-1208-9

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