Background and Purpose Published cohorts of children with arterial ischemic stroke (AIS) in the 1990s to early 2000s reported five-year cumulative recurrence rates approaching 20%. Since then, utilization of antithrombotic agents for secondary stroke prevention in children has increased. We sought to determine rates and predictors of recurrent stroke in the current era. Methods The Vascular effects of Infection in Pediatric Stroke (VIPS) study enrolled 355 children with AIS at 37 international centers from 2009–2014, and followed them prospectively for recurrent stroke. Index and recurrent strokes underwent central review and confirmation, as well as central classification of stroke etiologies, including arteriopathies. Other predictors were measured via parental interview or chart review. Results Of the 355 children, 354 survived their acute index stroke, and 308 (87%) were treated with an antithrombotic medication. During a median follow-up of 2.0 years (interquartile range, 1.0–3.0), 40 children had a recurrent AIS, and none had a hemorrhagic stroke. The cumulative stroke recurrence rate was 6.8% (95% CI 4.6–10%) at one month and 12% (8.5–15%) at one year. The sole predictor of recurrence was presence of an arteriopathy, which increased the risk of recurrence 5-fold compared to an idiopathic AIS (hazard ration 5.0, 95% CI 1.8–14). The one-year recurrence rate was 32% (95% CI 18–51%) for moyamoya, 25% (12–48%) for transient cerebral arteriopathy, and 19% (8.5–40%) for arterial dissection. Conclusions Children with AIS, particularly those with arteriopathy, remain at high risk for recurrent AIS despite increased utilization of antithrombotic agents. Therapies directed at the arteriopathies themselves are needed.

Objective Severe complications of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) include arterial ischemic stroke (AIS) in adults and multisystem inflammatory syndrome in children. Whether stroke is a frequent complication of pediatric SARS‐CoV‐2 is unknown. This study aimed to determine the proportion of pediatric SARS‐CoV‐2 cases with ischemic stroke and the proportion of incident pediatric strokes with SARS‐CoV‐2 in the first 3 months of the pandemic in an international cohort. Methods We surveyed 61 international sites with pediatric stroke expertise. Survey questions included: numbers of hospitalized pediatric (≤ 18 years) patients with SARS‐CoV‐2; numbers of incident neonatal and childhood ischemic strokes; frequency of SARS‐CoV‐2 testing for pediatric patients with stroke; and numbers of stroke cases positive for SARS‐CoV‐2 from March 1 to May 31, 2020. Results Of 42 centers with SARS‐CoV‐2 hospitalization numbers, 8 of 971 (0.82%) pediatric patients with SARS‐CoV‐2 had ischemic strokes. Proportions of stroke cases positive for SARS‐CoV‐2 from March to May 2020 were: 1 of 108 with neonatal AIS (0.9%), 0 of 33 with neonatal cerebral sinovenous thrombosis (CSVT; 0%), 6 of 166 with childhood AIS (3.6%), and 1 of 54 with childhood CSVT (1.9%). However, only 30.5% of neonates and 60% of children with strokes were tested for SARS‐CoV‐2. Therefore, these proportions represent 2.9, 0, 6.1, and 3.0% of stroke cases tested for SARS‐CoV‐2. Seven of 8 patients with SARS‐CoV‐2 had additional established stroke risk factors. Interpretation As in adults, pediatric stroke is an infrequent complication of SARS‐CoV‐2, and SARS‐CoV‐2 was detected in only 4.6% of pediatric patients with ischemic stroke tested for the virus. However, < 50% of strokes were tested. To understand the role of SARS‐CoV‐2 in pediatric stroke better, SARS‐CoV‐2 testing should be considered in pediatric patients with stroke as the pandemic continues. ANN NEUROL 2021;89:657–665

Background and Purpose Among children with arterial ischemic stroke (AIS), those with arteriopathy have the highest recurrence risk. We hypothesized that arteriopathy progression is an inflammatory process, and that inflammatory biomarkers would predict recurrent AIS. Methods In an international study of childhood AIS, we selected cases classified into one of the three most common childhood AIS etiologies: definite arteriopathic (N=103), cardioembolic (N=55), or idiopathic (N=78). We measured serum concentrations of high sensitivity C-reactive protein (hsCRP), serum amyloid A (SAA), myeloperoxidase (MPO), and tumor necrosis factor alpha (TNF-α). We used linear regression to compare analyte concentrations across the subtypes, and Cox proportional hazards models to determine predictors of recurrent AIS. Results Median age at index stroke was 8.2 years (IQR 3.6, 14.3); serum samples were collected at median 5.5 days post-stroke (IQR 3, 10 days). In adjusted models (including age, infarct volume, and time to sample collection) with idiopathic as the reference, the cardioembolic (but not arteriopathic) group had higher concentrations of hsCRP and MPO, while both cardioembolic and arteriopathic groups had higher SAA. In the arteriopathic (but not cardioembolic) group, higher hsCRP and SAA predicted recurrent AIS. Children with progressive arteriopathies on follow-up imaging had higher recurrence rates, and a trend towards higher hsCRP and SAA, compared to children with stable or improved arteriopathies. Conclusion Among children with AIS, specific inflammatory biomarkers correlate with etiology and—in the arteriopathy group—risk of stroke recurrence. Interventions targeting inflammation should be considered for pediatric secondary stroke prevention trials.

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Introducción: El trastorno del espectro autista (TEA) es un desorden neurobiológico altamente prevalente, cuyo diagnóstico clínico es un desafío constante.Objetivos: Describir el perfil clínico, en una cohorte de niños con TEA desde su derivación al especialista hasta la realización de un test diagnóstico.Pacientes y Método: Estudio descriptivo desde los primeros síntomas pesquisados por la madre, hasta la certificación diagnóstica de una serie de 50 niños, diagnosticados clínicamente con TEA entre 2012-2016. Se incluyeron niños de 3 a 10 años al momento del Test ADOS-G, con lenguaje de al menos una palabra. Los niños fueron evaluados neuropsicológicamente (funcionalidad, intelectualidad y test ADOS). Comparamos las medianas de edad al diagnóstico neurológico, según carga de sintomatología autista y nivel cognitivo.Resultados: El test ADOS corroboró un TEA en 44 niños (88%), 93,1% eran varones. La edad promedio al diagnóstico clínico y test ADOS fue 48,2 ± 18,3 y 62,6 ± 23,3 meses. La consulta neurológica en el 72% de los casos fue motivación parental/educador por síntomas como trastorno interacción social y retraso de lenguaje. El 34,1; 47,7 y 18,2% tenían sintomatología autista leve, moderada y severa respectivamente. En 5 de 27 niños en los que se realizó la evaluación neuropsicológica se detectó déficit cognitivo. La mediana de edad al diagnóstico fue significativamente menor en niños con sintomatología autista grave vs levemoderada (p 0,024).Conclusión: La sintomatología autista determina la precocidad de consulta, por lo que es necesario orientar a la población general, educadores y personal de salud, respecto a estos síntomas.