Mode of Onset Predicts Etiological Diagnosis of Arterial Ischemic Stroke in Children

Braun, Kees P.J.; Rafay, Mubeen F.; Uiterwaal, Cuno S.P.M.; Pontigon, Anne-Marie; deVeber, Gabrielle

doi:10.1161/01.str.0000254484.10680.c6

Cited by 59 publications

(38 citation statements)

References 19 publications

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“…6 The nonabrupt mode of onset of symptoms and the nonprogressive nature of the arteriopathies that we found in young adults are comparable to what has been observed in children with TCA. 14 In children with TCA, follow-up vascular imaging shows complete normalization in 23%, stabilization in 32%, and improvement in 45%. 6 Late recurrences are rare and clinical outcome is good in 41% of patients.…”

Section: Discussionmentioning

confidence: 98%

“…Onset was classified as "stuttering" when presenting symptoms were fluctuating and the patient was not free of symptoms between episodes and as "recurring" when the patient was free of symptoms in between. 14 The severity of stroke at presentation was classified according to the National Institutes of Health Stroke Scale and modified Rankin Scale.…”

Section: Methodsmentioning

confidence: 99%

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The Course of Unilateral Intracranial Arteriopathy in Young Adults With Arterial Ischemic Stroke

Bulder

Braun

Leeuwis

et al. 2012

Stroke

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Background and Purpose-Unilateral intracranial focal nonprogressive arteriopathy is often found in children with arterial ischemic stroke. We aimed to investigate the course of unilateral intracranial arteriopathy in young adults. Methods-We searched the Utrecht Stroke Database for patients between 16 and 50 years of age diagnosed with anterior circulation arterial ischemic stroke and a nonatherosclerotic, unilateral intracranial large-artery arteriopathy between 1991 and 2005. We assessed clinical features, potential causes, risk factors, extent of infarction and arteriopathy at presentation, long-term angiographic course, and clinical outcome. Results-Of 356 patients with anterior circulation arterial ischemic stroke, 17 (5%) had a documented unilateral intracranial arteriopathy, of whom 14 could be included for follow-up investigations (median age, 34 years; range, 27-49 years). Median duration of follow-up was 8.8 years (range, 1.7-12.8 years). In 11 patients, onset of symptoms was not abrupt. The arteriopathy normalized completely in 5 and improved in 3 patients; in none of the patients did the arteriopathy worsen. Two of 14 patients had recurrent symptoms. Ten patients (71%) had a good outcome (modified Rankin Scale score Յ2). Conclusions-In young adults, arterial ischemic stroke is rarely caused by a unilateral intracranial arteriopathy. Similar to children, onset of symptoms in young adults is often not abrupt and the arteriopathy may improve over time. Late recurrences were rare. Possibly, a monophasic inflammatory process, as has been suggested for childhood intracranial focal nonprogressive arteriopathies, also occurs in young adults. (Stroke. 2012;43:1890-1896.)

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Section: Discussionmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

The Course of Unilateral Intracranial Arteriopathy in Young Adults With Arterial Ischemic Stroke

Bulder

Braun

Leeuwis

et al. 2012

Stroke

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“…For focal neurological deficits, mode of onset was classified as previously defined. 15 "Abrupt" defined onset with progression to maximum deficit within 30 minutes or fixed deficits on awakening and "nonabrupt" as all others. Neurological examination findings at presentation were documented.…”

Section: Clinical Datamentioning

confidence: 99%

Delay to Diagnosis in Acute Pediatric Arterial Ischemic Stroke

Rafay

Pontigon

Chiang

et al. 2009

Stroke

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192

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Background and Purpose-For the clinician, the diagnosis of arterial ischemic stroke (AIS) in children is a challenge.Prompt diagnosis of pediatric AIS within 6 hours enables stroke-specific thrombolytic and neuroprotective strategies. Methods-We conducted a retrospective study of prospectively enrolled consecutive cohort of children with AIS, admitted to The Hospital for Sick Children, Toronto, from January 1992 to December 2004. The data on clinical presentation, symptom onset, emergency department arrival, neuroimaging and stroke diagnosis were recorded. The putative predictors of delayed diagnosis were selected a priori for analysis. Results-A total of 209 children with AIS were studied. The median interval from symptom onset to AIS diagnosis was 22.7 hours (interquartile range: 7.1 to 57.7 hours), prehospital delay (symptom onset to hospital arrival) was 1.7 hours (interquartile range: 49 minutes to 8.1 hours), and the in-hospital delay (presentation to diagnosis) was 12.7 hours (interquartile range: 4.5 to 33.5 hours). The initial assessment was completed in 16 minutes and initial neuroimaging in 8.8 hours. The diagnosis of AIS was suspected on initial assessment in 79 (38%) children and the initial neuroimaging diagnosed AIS in 47%. The parent's help seeking action, nonabrupt onset of symptoms, altered consciousness, milder stroke severity, posterior circulation infarction and lack of initial neuroimaging at a tertiary hospital were predictive delayed AIS diagnosis. Conclusion-In the diagnosis of AIS, significant prehospital and in-hospital delays exist in children. Several predictors of the delayed AIS diagnosis were identified in the present study. Efforts to target these predictors can reduce diagnostic delays and optimize the management of AIS in children.

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“…Moreover, corroborating the diagnosis of PVA, the arteriopathy took a monophasic course with subsequent stenosis regression, which was proved to be the most common clinical evolution 3 . The mode of onset of stroke in our patient was with multiple TIAs, which was demonstrated to predict an underlying artheriopathy 4 . This fact guided us to perform vascular imaging as soon as possible, which led to the diagnosis of PVA in the second day after admission.…”

Section: Discussionmentioning

confidence: 54%

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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Mode of Onset Predicts Etiological Diagnosis of Arterial Ischemic Stroke in Children

Cited by 59 publications

References 19 publications

The Course of Unilateral Intracranial Arteriopathy in Young Adults With Arterial Ischemic Stroke

The Course of Unilateral Intracranial Arteriopathy in Young Adults With Arterial Ischemic Stroke

Delay to Diagnosis in Acute Pediatric Arterial Ischemic Stroke

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

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