Please see the Appendix for a list of the members of the International Pediatric Stroke Study Group.
Arterial ischemic stroke risk factors: The international pediatric stroke study†
Article first published online: 28 JAN 2011
Copyright © 2010 American Neurological Association
Annals of Neurology
Volume 69, Issue 1, pages 130–140, January 2011
How to Cite
Mackay, M. T., Wiznitzer, M., Benedict, S. L., Lee, K. J., deVeber, G. A., Ganesan, V. and on behalf of the International Pediatric Stroke Study Group (2011), Arterial ischemic stroke risk factors: The international pediatric stroke study. Ann Neurol., 69: 130–140. doi: 10.1002/ana.22224
- Issue published online: 28 JAN 2011
- Article first published online: 28 JAN 2011
- Manuscript Accepted: 6 AUG 2010
- Manuscript Revised: 1 AUG 2010
- Manuscript Received: 15 FEB 2010
To describe presumptive risk factors (RFs) for childhood arterial ischemic stroke (AIS) and explore their relationship with presentation, age, geography, and infarct characteristics.
Children (29 days–18 years) were prospectively enrolled in the International Pediatric Stroke Study. Risk factors, defined conditions thought to be associated with childhood AIS, were divided into 10 categories. Chi-square tests were used to compare RFs prevalence across regions and age; logistic regression was used to determine whether RFs were associated with particular features at presentation or infarct characteristics.
A total of 676 children were included. No identifiable RFs was present in 54 (9%). RFs in others included arteriopathies (53%), cardiac disorders (CDs) (31%), infection (24%), acute head and neck disorders (AHNDs) (23%), acute systemic conditions (ASCs) (22%), chronic systemic conditions (CSCs) (19%), prothrombotic states (PTSs) (13%), chronic head and neck disorders (CHNDs) (10%), atherosclerosis-related RFs (2%), and other (22%). Fifty-two percent had multiple RFs. There was lower prevalence of arteriopathy in Asia, lower prevalence of CSCs in Europe and Australia, higher prevalence of PTSs in Europe, and higher prevalence of ASCs in Asia and South America. Prevalence of CDs and ASCs was highest in preschoolers, arteriopathies in children 5 to 9 years old, and CHNDs were highest in children aged 10 to 14 years. Arteriopathies were associated with focal signs and ASCs, CHNDs, and AHNDs with diffuse signs. Arteriopathies, CSCs, and ASCs were associated with multiple infarcts and CDs with hemorrhagic conversion.
RFs, especially arteriopathy, are common in childhood AIS. Variations in RFs by age or geography may inform prioritization of investigations and targeted preventative strategies. Ann Neurol 2011;69:130–140.