Inherited and acquired risk factors and their combined effects in pediatric stroke

Barreirinho, Sameiro; Ferro, Anabela; Santos, Mariline; Costa, Elı́sio; Pinto‐Basto, Jorge; Sousa, Alda; Sequeiros, Jorge; Maciel, Patrı́cia; Barbot, Clara; Barbot, José

doi:10.1016/s0887-8994(02)00506-4

Cited by 67 publications

(45 citation statements)

References 13 publications

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“…4,5 Histories of important risk factors, including smoking, hyperlipidemia, hypertension, diabetes mellitus and positive family histories were elicited from all patients and controls.…”

Section: Methodsmentioning

confidence: 99%

Clinical profile, common thrombophilia markers and risk factors in 85 young Indian patients with arterial thrombosis

Mishra¹,

Kalra

Rohatgi

2013

Sao Paulo Med. J.

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CONTEXT AND OBJECTIVE: Arterial thrombosis may occur consequent to hereditary thrombophilia and increased lipoprotein(a) [Lp(a)] and fibrinogen. Our aim was to study the prevalence of common thrombophilia markers in 85 consecutive cases of arterial thrombosis. DESIGN AND SETTING: A retrospective study was conducted from 85 consecutive young patients treated as outpatients or admitted due to stroke or myocardial infarction at a tertiary care hospital. METHODS: Eighty-five Indian patients (age < 45 years) presenting ischemic stroke (n = 48) or myocardial infarction (n = 37) and 50 controls were studied for seven thrombophilia markers including antithrombin (AT), factor V, protein C, protein S, activated protein C resistance (APC-R), fibrinogen and Lp(a). Functional assays for protein C, protein S, factor V and APC-R were performed using clotting-based methods. Semi-quantitative estimation of fibrinogen was done using Clauss's method and Lp(a) using immunoturbidimetry. Statistical analysis was done using the Epi Info 6 software. RESULTS: Thirty-three samples (38.8%) tested positive for one or more thrombophilia markers. The three commonest abnormalities were elevated Lp(a) (20%), fibrinogen (17.6%) and low APC-R (14.2%). Low levels of protein C, protein S and AT were present in 4.7, 9.4 and 7% of the patients, respectively. Overall, the risk factor profile was: smoking (33%), positive family history (15.3%), hyperlipidemia (7%), hypertension, diabetes mellitus and obesity (2.3% each). CONCLUSIONS: An association was found between low levels of protein C, protein S and AT and arterial thrombosis, but only elevated fibrinogen levels, smoking, positive family history and hyperlipidemia showed statistical significance.

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“…4,5 Histories of important risk factors, including smoking, hyperlipidemia, hypertension, diabetes mellitus and positive family histories were elicited from all patients and controls.…”

Section: Methodsmentioning

confidence: 99%

Clinical profile, common thrombophilia markers and risk factors in 85 young Indian patients with arterial thrombosis

Mishra¹,

Kalra

Rohatgi

2013

Sao Paulo Med. J.

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“…Thus is crucial to perform a complete investigation which should include vascular imaging, cardiac evaluation and prothrombotic testing 16 . Actually, although stroke in children is commonly associated with the presence of both genetic and acquired risk factors 17 this is one of the rare patients reported in the literature with stroke and PVA combined with a prothrombotic disorder 18 . The rarity of this finding, can be due to the underinvestigation of additional risk factors in children with varicella and stroke which would justify at least partially why only some children with varicella develop AIS, an issue that diserves documentation in further studies.…”

Section: Discussionmentioning

confidence: 96%

Transient ischemic attacks in a child with post-varicella arteriopathy and MTHFR homozigotic mutation C677T

Beleza

Fernandes

Afonso

et al. 2008

Arq. Neuro-Psiquiatr.

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acidenTes isquÊmicos TransiTórios em criança com arTeriopaTia pós-varicela e muTação mThFr c677T homozigóTica. Chickenpox is the primary etiologic agent involved in 60% of cases and usually carries a good prognosis 2 . We report on a patient with multiple transients ischemic attacks (TIA) who presented a post-varicella artheriopathy (PVA) associated with MTHFR homozigotic mutation C677T. Moreover the diagnosis criteria and therapy of PVA is discussed. caseA three year-old boy was admitted to the emergency room (ER) with sudden onset of transient motor deficit of both left limbs. The neurological and general examination was normal. His past medical history was remarkable for primary varicella infection occurring five months before. In the ER he underwent blood tests, brain CT and EEG which displayed normal results. While performing EEG, he presented another deficit episode lasting for five minutes and similar to the one previously described. In the light of multiple TIA's, anticoagulation with heparin was initiated. However, he had three more TIA's in the same territory, and at the fifth day after admission had sudden onset of a left pyramidal syndrome with discrete hemiparesis.The heart evaluation including electrocardiogram and echocardiogram was normal. Noteworthy, concearning the analytical work-up, we underscore the serologic evidence of a non-recent VVZ infection (IgG+, IgM-) and the presence of a MTHFR homozigotic mutation C677T with normal homocystein and folic acid. All the remaining study was normal or negative and included hemogram, biochemistry, immunologic study, metabolic, protrombotic and CSF (cytochemistry, serologic, microbiologic and virus PCR including VVZ). The MRI with Angio-MRI performed at the second day after admission showed a recent stroke in the territory of right lenticulostriate arteries and a decreased flow on the M1-M2 transition of right MCA (Fig 1). A brain conventional angiography was performed to better study all the brain vascular system including the distal vessels. The intracranial es-

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“…Deficiencies of PC, PS and AT were also linked to childhood arterial ischemic stroke in a number of studies [28][29][30][31]. PC deficiency has been identified in 0-22% of children with arterial ischemic stroke in cohort studies [29,30,32,33].…”

Section: Hypercoagulabilitymentioning

confidence: 99%

“…PC deficiency has been identified in 0-22% of children with arterial ischemic stroke in cohort studies [29,30,32,33]. PS deficiency has been less commonly associated with arterial ischemic stroke in children, being reported in 0-10.7% depending on the different studies [29,30,32]. By contrast, a number of studies failed to demonstrate an association between AT deficiency and childhood arterial ischemic stroke [29,32].…”

Section: Hypercoagulabilitymentioning

confidence: 99%

“…PS deficiency has been less commonly associated with arterial ischemic stroke in children, being reported in 0-10.7% depending on the different studies [29,30,32]. By contrast, a number of studies failed to demonstrate an association between AT deficiency and childhood arterial ischemic stroke [29,32]. Elevated levels of lipoprotein(a), however, were found with higher frequency in 148 children with arterial ischemic stroke compared to controls [25].…”

Section: Hypercoagulabilitymentioning

confidence: 99%

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Inherited and acquired risk factors for arterial ischemic stroke in childhood

Lippi

Franchini

Montagnana

et al. 2008

J Thromb Thrombolysis

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Ischemic stroke in childhood is a rare but serious disorder, which is associated with significant morbidity and mortality. The lack of causal homogeneity in the aetiology of this disorder presents problems for predicting and preventing it, making the ischemic stroke in childhood a real dilemma for the clinician. Although a variety of potential inherited and acquired causes have been now identified, including cardiac pathologies, infections, prothrombotic, metabolic and vascular disorders, the aetiology of ischemic stroke in the young remains still unknown in more than one third of the patients. Presently, an appropriate evaluation of some hypercoagulable conditions seems justified in adults with stroke. However, the etiologic contribution of several thrombophilic conditions to initial and recurrent stroke in affected children has not been definitely clarified, since more powerful and influential non-thrombophilic risk factors are usually present, making the thrombophilia screening in such circumstance a matter of debate. In particular, the diagnostic yield of the screening is reportedly lower in children, the role of several prothrombotic abnormalities is uncertain, especially in recurrent stroke, and there is no evidence-based guidance to stroke prevention and therapy in children carrying a hypercoagulable state. Additional studies are needed to quantify the risk for a cerebrovascular event in children with a prothrombotic disorder and to determine which combination of endogenous and exogenous risk factors leads to greater rates of initial and recurrent stroke.

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Inherited and acquired risk factors and their combined effects in pediatric stroke

Cited by 67 publications

References 13 publications

Clinical profile, common thrombophilia markers and risk factors in 85 young Indian patients with arterial thrombosis

Clinical profile, common thrombophilia markers and risk factors in 85 young Indian patients with arterial thrombosis

Transient ischemic attacks in a child with post-varicella arteriopathy and MTHFR homozigotic mutation C677T

Inherited and acquired risk factors for arterial ischemic stroke in childhood

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