Predictors of Cerebral Arteriopathy in Children With Arterial Ischemic Stroke

Abstract

Background Cerebral arteriopathies, including an idiopathic focal cerebral arteriopathy of childhood (FCA), are common in children with arterial ischemic stroke (AIS) and strongly predictive of recurrence. To better understand these lesions, we measured predictors of arteriopathy within a large international series of children with AIS. Methods and Results Between 1/2003 and 7/2007, 30 centers within the International Pediatric Stroke Study (IPSS) enrolled 667 children (29 days-19 years of age) with AIS and abstracted clinical and radiographic data. Cerebral arteriopathy and its subtypes were defined using published definitions; FCA was defined as cerebral arterial stenosis not attributed to specific diagnoses such as moyamoya, arterial dissection, vasculitis, or post-varicella angiopathy. We used multivariate logistic regression techniques to determine predictors of arteriopathy and FCA among those subjects who received vascular imaging. The authors had full access to and take full responsibility for the integrity of the data. All authors have read and agree to the manuscript as written. Of 667 subjects, 525 had known vascular imaging results, and 53% of those (n=277) had an arteriopathy. The most common arteriopathies were FCA (n=69, 25%), moyamoya (n=61, 22%), and arterial dissection (n=56; 20%). Predictors of arteriopathy include early school age (5-9 years), recent upper respiratory infections (URI), and sickle cell disease, while prior cardiac disease and sepsis reduced the risk of arteriopathy. The only predictor of FCA was recent URI. Conclusions Arteriopathy is prevalent among children with AIS, particularly those presenting in early school age, and those with a history of sickle cell disease. Recent URI predicted cerebral arteriopathy, and FCA in particular, suggesting a possible role for infection in the pathogenesis of these lesions.

Pediatric Neurocritical Care

“…The pathophysiology underlying these descriptive findings is not known. Recent upper respiratory infection has been identified as a risk factor [137]. Angiopathy following varicella infection has been previously associated with ischemic stroke in adults and children, as with other viruses that have been linked in case reports to ischemic stroke in children [139].…”

“…Arteriopathies has been identified up to 60% of pediatric patients with AIS [137]. The presence of arteriopathy strongly predicts stroke recurrence [138].…”

“…Known arteriopathies include Moyamoya disease, arterial dissection, and vasculitis. Recently, a focal cerebral arterial stenosis without an apparent cause or an associated illness has also been described [137]. Described in previous studies as "transient cerebral arteriopathy," these characteristically involve the distal internal cerebral artery, proximal middle cerebral artery, or the proximal anterior cerebral artery unilaterally, and they stabilize or improve after a 6-month period [139].…”

Failure to Impact Prevalence of Arterial Ischemic Stroke in Pediatric Cardiac Patients over Three Decades

“…Using data collected over the previous three decades and published over the last decade, 3,7,12,13 the prevalence of cardiac disease in AIS was approximately 20-26%. In 2000, Lanthier et al 12 published a prevalence of 20% in data collected from 1991 to 1997, and de Veber (abstract) 3 reported a prevalence of 26%.…”

“…In 2003, Ganesan et al 7 published a prevalence of 22% in data collected from 1978 to 2000. In 2009, Amlie-Lefond et al 13 published a prevalence of 26% in data collected from 2003 to 2007. The prevalence in our population was similar at 25%.…”