Investigation of risk factors in children with arterial ischemic stroke

Authors

  • Vijeya Ganesan MD,

    Corresponding author
    1. Neurosciences Unit, University College London, United Kingdom
    2. Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, United Kingdom
    • Lecturer in Paediatric Neurology, Neurosciences Unit, Institute of Child Health (UCL), The Wolfson Centre, Mecklenburgh Square, London WC1N 2AP
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  • Mara Prengler MD,

    1. Neurosciences Unit, University College London, United Kingdom
    2. Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
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  • Michael A. McShane MB, BCh,

    1. Neurosciences Unit, University College London, United Kingdom
    2. Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
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  • Angela M. Wade PhD,

    1. Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, United Kingdom
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  • Fenella J. Kirkham MB, BChir

    1. Neurosciences Unit, University College London, United Kingdom
    2. Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
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Abstract

We present data on the known risk factors encountered in children presenting with a first arterial ischemic stroke to a single tertiary center over 22 years. Two hundred twelve patients (54% male; median age, 5 years) were identified. One hundred fifteen (54%) were previously healthy. Cerebral arterial imaging was undertaken in 185 patients (87%) and was abnormal in 79%. Of 104 previously healthy patients investigated with echocardiography, only 8 had abnormal studies. Genetic or acquired conditions causing thrombophilia were rare. Forty percent of patients were anemic, and 21% either had elevated total plasma homocysteine or were homozygous for the t-MTHFR mutation. Trauma and previous varicella zoster infection were significantly more common in the previously healthy group. There was a significant association between cerebral arterial abnormalities and systolic blood pressure greater than 90th percentile and a trend for an association with varicella within the previous year. Clinical history and examination usually identify underlying risk factors and precipitating triggers for arterial ischemic stroke in childhood. Cerebral arterial imaging is usually abnormal, but echocardiography and prothrombotic screening are commonly negative. Ann Neurol 2003

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