We report on eight children who suffered from cerebrovascular ischemia or stroke at the age of 2 or up to 11 years. Antiphospholipid antibodies (APLA) were detected in two cases during the ischemic event and in six cases during follow-up examinations (after six weeks or within a span of six years). In two patients multiple stenoses of basal cerebral arteries were found; one of them suffered from moyamoya syndrome. The acute hemiplegia in one patient was linked to an asymptomatic mycoplasmal infection and APLA. In three cases, one of the parents was also APLA-positive. Seven patients were treated with acetylsalicylic acid, and in four cases immunoglobulin infusions were given. Transient ischemic attacks subsided after the child with the moyamoya syndrome received immunoglobulins. No effect of medication could be established in the other children. The concept of the antiphospholipid syndrome is still evolving. As none of the common risk factors pertaining to strokes in adults apply to children, pediatric research may offer a suitable platform for specific investigations on the causal, pathogenetic role of APLA. We propose that all children suffering from stroke or transient ischemic attacks should be tested for APLA.

In most cases the etiology of the focal ischemic stroke in newborns is still obscure. We considered patients with congenital hemiparesis due to a lesion in the territory of the middle cerebral artery (shown by CT or MRI) as a model of this infarction. A detailed history including maternal and familiar data was obtained from 9 affected patients. Duplex-sonography was performed and biochemical parameters were analysed in all patients and their mothers. There were no convincing hints for a prenatal (for instance infectious, traumatic or toxic) origin. Also the reconstruction of the perinatal period could not explain the infarction. Duplex-sonography revealed no anatomic variants of the intra- or extracerebral arteries. Haemostasiological results were within normal limits--except the antiphospholipid antibodies, which were detected in 7 of the 9 families (patient or mother). The significance of these results is still unknown. We propose, antiphospholipid antibodies and further haemostasiological parameters should be investigated as near as possible to the neonatal period.

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