Prethrombotic Disorders in Children With Arterial Ischemic Stroke and Sinovenous Thrombosis

Bonduel, Mariana; Sciuccati, Gabriela; Hepner, Mirta; Torres, Aurora Feliú; Pieroni, Graciela; Frontroth, Juan Pablo

doi:10.1001/archneur.56.8.967

Cited by 106 publications

(72 citation statements)

References 39 publications

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“…The female sex was most affected in the present study with 52% of the cases contrary to the great majority of the other studies where the male sex represents between 50 and 60% of the cases 7,11,12,[14][15][16][17] . Perhaps this is due to the association of the male sex with arterial trauma dissection as a basic cause of AIS 18 , which did not occur in this study.…”

Section: Discussioncontrasting

confidence: 93%

“…Ganesan et al found that hemiparesis was the most prevalent symptom in the initial phase (83%) followed by seizures (33%) in children with 3 months or more 13 . Bonduel et al also in a study with infants, reported that hemiparesis and seizures were the most frequent initial symptoms 7 . In a study confined to full-term newborn, Gunther et al reported that seizures were part of the initial clinical presentation in 77% of the cases and the focal crises were the most common 9 .…”

Section: Discussionmentioning

confidence: 91%

“…Several infectious agents cause AIS in children26 and are considered risk factors with frequency variations between 6-17% 1,7 . This present research detected 31% of acute infections associated to strokes.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of investigators have stressed the importance of a complete investigation in a considerable portion of the cases excluding those where the cause is very obvious. Prothrombotic disorders have received special attention in recent researches in view of the fact that thromboembolic events are the major factors caus-ing AIS in children 6,7 . Examples of coagulation defects are: S and C protein deficiencies, antithrombin deficiencies, and the presence of resistance to the activated C protein and plasminogen deficiencies 1 .…”

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confidence: 99%

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Ischemic stroke in children: a study of the associated alterations

Ranzan

Rotta

2004

Arq. Neuro-Psiquiatr.

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-Arterial ischemic stroke (AIS) in children is a relatively rare disease, not yet clearly understood and with a multifactored etiology. It can cause a severe impact on the child and be the first manifestation of a systemic disease. Delayed diagnosis is still common and research on the subject in our field practically does not exist. Prothrombotic disorders have been described as important causative factors of the ischemic event in children. Forty-six patients from zero to 18 years of age diagnosed with AIS were studied in the period between March 2002 and September 2003. Laboratory tests were realised including coagulation proteins and echocardiogram. AIS of the newborn occurred in 37% of the cases. Focal seizures and hemiparesis were the most frequent symptoms; 40% of the patients presented prior pathologies. Abnormalities of the S and C proteins occurred in 22% and 17%. Associated alterations, particularly those that generate a hypercoagulability state, indicate more than one risk factor for this disease in childhood.KEY WORDS: cerebrovascular disease, coagulation disorders, children. Acidente vascular cerebral isquêmico na infância: estudo das alterações associadasRESUMO -Acidente vascular cerebral Isquêmico (AVCI) na infância é relativamente raro, de conhecimento ainda obscuro, e com etiologia multifatorial. Pode causar grave impacto na criança e ser a primeira manifestação de doença sistêmica. O subdiagnóstico ainda é comum e são praticamente inexistentes as pesquisas sobre o assunto no nosso meio. Desordens protrombóticas têm sido descritas como importantes fatores causais do evento isquêmico na infância. Foram estudados 46 pacientes de zero a 18 anos, com diagnósti-co de AVCI, no período de março/2002 a setembro/2003. Exames laboratoriais, incluindo proteínas de coagulação e ecocardiograma foram realizados. AVCI neonatal ocorreu em 35% dos casos. Crise focal e hemiparesia foram os sintomas iniciais mais freqüentes; 40% dos casos apresentaram patologia prévia. Anormalidades nas proteínas S e C ocorreram em 22% e 17% da amostra. Alterações associadas, principalmente as que geram um estado hipercoagulável, indicam que mais de um fator de risco pode causar essa doença na infância. PALAVRAS-CHAVE: doença cerebrovascular,desordens da coagulação, infância.

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Section: Discussioncontrasting

confidence: 93%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Ischemic stroke in children: a study of the associated alterations

Ranzan

Rotta

2004

Arq. Neuro-Psiquiatr.

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“…In older children with AIS, the data has been conflicting and has been hampered by the small number of cases in some of the published studies (Bonduel et al, 1999;McColl et al, 1999;Nowak-Gottl et al, 1999;Strater et al, 1999;Kenet et al, 2000). Nevertheless, there does seem to be a trend towards an increased incidence of prothrombotic abnormalities in older children with AIS Chan et al, 2000).…”

Section: Fetal and Neonatal Thrombophiliamentioning

confidence: 99%

Perinatal stroke – risk factors and management

Chalmers

2005

Br J Haematol

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SummaryStroke is an uncommon but increasingly recognised cause of mortality and long-term neurological morbidity in children. A significant number of these events appear to be caused by thromboembolic disease and, as with other childhood thrombotic problems, the incidence of central nervous system events appears highest during the neonatal period. In contrast to peripheral arterial and venous thrombotic problems, it is likely that a proportion of cerebral thromboembolic events occur either in utero or perinatally and reflect different risk factors from those occurring in older infants and children. The pathophysiology of perinatal stroke is complex and in many cases is likely to be multifactorial. It is now recognised that risk factors may relate to both maternal and placental problems as well as fetal and neonatal disorders. Large prospective studies of perinatal stroke are currently lacking and efforts to define the relative contribution from each of these areas are at an early stage. The complex nature of these disorders requires collaboration between a number of different disciplines including obstetrics, fetal medicine, pathology, neonatology and neurology. Of particular interest to haematologists is the possible impact of prothrombotic abnormalities in the pathophysiology of these events and also the potential for the use of antithrombotic agents in both management and prevention.

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Factor V leiden and prothrombin gene G20210A mutation in children with cerebral thromboembolism

et al. 2003

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We investigated whether there is an association between factor V Leiden (FVL) and/or prothrombin gene G20210A mutation (PT20210A) and cerebral thromboembolism in a pediatric Argentinean population. From May 1992 to January 2002, 44 consecutive children with arterial ischemic stroke (AIS) and 23 children with cerebral sinovenous thrombosis (SVT) were prospectively studied at a single center. The prevalence of both mutations was compared with a 102 age-matched controls. In children with AIS, the frequencies (patients vs. controls), odds ratio (OR), and 95% confidence interval (95% CI) for the presence of FVL were as follows: 2.3% vs. 2%, OR/95% CI, 1.16/0.2 to 13.2; P value = 0.99. No cases of PT20210A were found in this group. In children with SVT, the frequencies (patients vs. controls), OR, and 95% CI were as follows: FVL (4.3% vs. 2%, OR/95% CI, 2.27/0.22 to 6.2; P value = 0.99) and PT20210A (4.3% vs. 1%; OR/95% CI, 4.6/0.3 to 76.3; P value = 0.3354). One child with PT20210A also had an inherited protein C deficiency. In 12 (18%) out of the 67 children with cerebral thromboembolism, without the aforementioned mutations, other prothrombotic disorders were detected. Although a multi-center prospective study with a large number of Argentinean pediatric patients is needed to obtain considerable evidence, no association between factor V Leiden and/or prothrombin gene G20210A mutation and cerebral thromboembolism was found in this pediatric series. Am. J. Hematol. 73:81-86, 2003.

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Prethrombotic Disorders in Children With Arterial Ischemic Stroke and Sinovenous Thrombosis

Cited by 106 publications

References 39 publications

Ischemic stroke in children: a study of the associated alterations

Ischemic stroke in children: a study of the associated alterations

Perinatal stroke – risk factors and management

Factor V leiden and prothrombin gene G20210A mutation in children with cerebral thromboembolism

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