Posterior circulation stroke in childhood

Ganesan, Vijeya; Chong, W.K.; Cox, Timothy C.; Chawda, Sanjiv; Prengler, Mara; Kirkham, Fenella J.

doi:10.1212/01.wnl.0000033092.87560.1a

Cited by 112 publications

(102 citation statements)

References 17 publications

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“…Rigorous analysis of vascular imaging studies followed an implemented standard reading protocol. For proximal large vessel stenotic lesions, MRA and conventional angiography have excellent concordance for the detection of abnormalities (18,19). However, distal stenoses were underestimated by MRA (21% of patients with nonprogressive cPACNS on MRA versus 38% on conventional angiography), which is consistent with the findings of previous studies.…”

Section: Discussionsupporting

confidence: 89%

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Primary central nervous system vasculitis in children

Benseler¹,

Silverman²,

Aviv³

et al. 2006

Arthritis & Rheumatism

196

185

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Objective. Primary angiitis of the central nervous system (PACNS) is a severe and ill-defined neurologic disease. The goal of this study was to characterize the presenting features, treatment, and neurologic outcome of PACNS in children (cPACNS) and to define the predictors of disease progression in order to identify high-risk patients with cPACNS.Methods. The cohort comprised consecutive patients diagnosed as having cPACNS based on clinical and vascular imaging findings, including identification of arterial stenosis on conventional angiography or magnetic resonance (MR) angiography. Disease progression was defined angiographically at >3 months after initial angiography. Clinical data obtained in prospectively collected standardized assessments and results of laboratory tests, including detection of cerebrospinal fluid abnormalities, were noted, and neuroimaging studies were reanalyzed. Predictors of progression were identified and tested in multivariate regression models.Results. Sixty-two consecutive patients with cPACNS (38 male, 24 female, median age 7.2 years) were included. Two distinct subgroups were identified, those with progressive disease and those with nonprogressive disease. Progressive cPACNS was found in 20 of 62 children and was predicted by a clinical presentation of neurocognitive dysfunction, multifocal parenchymal lesions on MR imaging, and evidence of distal stenoses on angiography.Conclusion. The spectrum of PACNS in children includes both progressive and nonprogressive forms. Characteristic features at diagnosis can be used to predict later progression, to identify a distinct high-risk cPACNS cohort, and to help guide selection of patients for immunosuppressive therapy.

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Section: Discussionsupporting

confidence: 89%

“…Finally, comparison of the degree of stenosis between MRA and conventional angiography films could be problematic, since MRA has been reported to overestimate the degree of stenosis (18,19). However, a difference in diameter of 25% would minimize this effect.…”

Section: Discussionmentioning

confidence: 99%

Primary central nervous system vasculitis in children

Benseler¹,

Silverman²,

Aviv³

et al. 2006

Arthritis & Rheumatism

196

185

View full text Add to dashboard Cite

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“…5,20,21 These poor outcomes are compounded by a high recurrence rate, estimated at 20% to 33%. 14,22,23 Both outcome and recurrence risk depend on the underlying cause, of which there are many in children. 18,24,25 Basilar artery stroke is uncommon in children but likely carries a similarly dismal prognosis to that of adults.…”

Section: Arterial Ischemic Stroke In Childrenmentioning

confidence: 99%

Successful Endovascular Therapy for Acute Basilar Thrombosis in an Adolescent

et al. 2003

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“…[5][6][7] Childhood BAS is rare, but the precise incidence is not known. Childhood AIS involves the vertebrobasilar territory in 2.2 to 36% of cases, 8,9 including cerebellar and occipital lobe infarcts. Published data on isolated childhood BAS consist mainly of individual case reports and small case series.…”

mentioning

confidence: 99%

Basilar artery strokes in children: good outcomes with conservative medical treatment

Lagman-Bartolome

Pontigon

Moharir

et al. 2013

Develop Med Child Neuro

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Aim To describe outcomes and outcome predictors in childhood basilar artery stroke (BAS). Method We prospectively enrolled children with BAS with or without basilar artery occlusion (BAO) in the Toronto Children's Stroke Registry from 1992 to 2009. We assessed presenting features and outcomes including Pediatric Stroke Outcome Measure scores. Results Among 578 children with acute arterial ischemic stroke, 27 had BAS (4.6% including neonates, 6% excluding neonates). Twenty‐four (14 males, 10 females) children met study criteria (mean age at stroke was 8y 10mo; range 0–17y). Eleven children had BAO. Aspirin or anticoagulation was given to 15 children. None received tissue plasminogen activator or endovascular treatments. At mean follow‐up (3y 2mo, range 1mo–11y 8mo), 12 had a ‘good outcome’ (seven normal, five insignificant deficit) and 12 had ‘poor outcome’ (10 moderate or severe deficit, two acute deaths). Larger infarct size (≥50% of axial brainstem diameter) independently predicted poor outcome (p=0.02; odds ratio 21.2, 95% confidence interval 1.6–274.9) but not BAO, altered level of consciousness, or age. Interpretation Compared with adults, in childhood BAS death is rare and survivors frequently have good outcomes. Aggressive endovascular interventions may not be justifiable in this population.

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Posterior circulation stroke in childhood

Cited by 112 publications

References 17 publications

Primary central nervous system vasculitis in children

Primary central nervous system vasculitis in children

Successful Endovascular Therapy for Acute Basilar Thrombosis in an Adolescent

Basilar artery strokes in children: good outcomes with conservative medical treatment

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