Cryptogenic posterior circulation stroke in children

Abstract

Posterior circulation arterial ischaemic stroke (PCAIS) in the paediatric age group accounts for 8% to 37% of arterial ischaemic stroke in children. [1][2][3][4] Cervicocephalic arterial dissections are the most common aetiological factors for PCAIS, as opposed to intracranial vasculopathies and cardioembolic factors in anterior circulation stroke in children. 1 Besides head and neck trauma, craniovertebral junction (CVJ) abnormalities are another cause of PCAIS in childhood. Although there are case series describing the aetiological and risk factor profile of PCAIS, CVJ anomalies have rarely been reported. 2-4 Furthermore, there is a significant delay between PCAIS presentation and CVJ anomaly diagnosis ranging from 1 month to 13 years; the recurrence risk is also high for this group of children with PCAIS. 1,5 Although described rarely in literature, the prevalence of CVJ anomalies may be higher in paediatric posterior circulation stroke. In this study, we describe six children presenting with PCAIS due to CVJ anomalies over 3 years and review the literature on the incidence of CVJ anomalies in PCAIS and diagnostic and surgical challenges in these children. M ET HODThe case files of children admitted to a tertiary care paediatric centre between July 2017 and December 2020 with evidence of stroke on imaging were retrieved and analysed retrospectively. Children with PCAIS attributed to CVJ anomaly were included, whereas haemorrhagic stroke and

Establishing a pediatric acute stroke protocol: experience of a new pediatric stroke program and predictors of acute stroke

“…It is common for children with acute ischemic stroke to present with seizure, headache, and non-specific symptoms in addition to focal findings like aphasia and hemiparesis commonly described in adult stroke patients ( 9 , 10 ). About 20% of acute ischemic stroke in children is posterior circulation ( 8 , 11 , 12 ). Childhood stroke affects ~1 in 25,000 children per year, with approximately 75% of children suffering long term neurologic morbidity ( 13 ).…”