Stroke in children: inherited and acquired factors and age‐related variations in the presentation of 48 paediatric patients

Balzo, Francesca Del; Spalice, Alberto; Ruggieri, Martino; Greco, Filippo; Properzi, Enrico; Iannetti, Paola

doi:10.1111/j.1651-2227.2009.01290.x

Cited by 23 publications

(22 citation statements)

References 22 publications

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“…Although seizures are often considered cortically based, and cortical infarcts have been identified as a risk factor for recurrent seizures (21), in our cohort several children with isolated subcortical infarcts had seizure on presentation. This observation is consistent with prior reports in children (21) and adults (19, 24, 35). Prior studies have reported that presence of seizures at presentation predicted involvement of the anterior circulation and cortical structures (9, 15, 17, 35).…”

Section: Discussionsupporting

confidence: 94%

“…One study of 76 children with ischemic stroke aged 44 weeks to 19 years reported that children less than 1 year of age were significantly more likely to present with seizure (33). In contrast, a study of 48 children with ischemic and hemorrhagic stroke reported that children older than 1 year of age were more likely to present with seizures (19). Developmentally determined differences in neurotransmitter receptor composition, number, and distribution favor a state of enhanced excitability in immature versus mature brain (34).…”

Section: Discussionmentioning

confidence: 98%

“…No child in our study had an isolated seizure without associated focal neurologic deficits. Studies that have included children with AIS, intracerebral hemorrhage, and sinovenous thrombosis have reported seizures in 27–58% at presentation (16–19) or within the initial several weeks (20, 21). This is consistent with a large number of adult stroke studies that report early seizures (22), variably defined as within the first 24 hours or several weeks, as occurring in 2–33% (23–29), with the majority occurring within the first 24 hours (30–32).…”

Section: Discussionmentioning

confidence: 99%

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Seizures as a Presenting Symptom of Acute Arterial Ischemic Stroke in Childhood

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Beslow

Smith

et al. 2011

The Journal of Pediatrics

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Objectives To define incidence of seizures as a presenting symptom of acute arterial ischemic stroke (AIS) in children and to determine whether younger age, infarct location, or AIS etiology were risk factors for seizure at AIS presentation. Study design Children aged 2 months to 18 years presenting with AIS from January 2005 to December 2008 were identified from a single center prospective pediatric stroke registry. Clinical data were abstracted, and a neuroradiologist reviewed imaging studies. Results Among 60 children who met inclusion criteria, seizures occurred at stroke presentation in 13 (22%). Median age was significantly younger in children who presented with seizures than in those who did not (1.1 versus 10 years, p=0.0009). Seizures were accompanied by hemiparesis in all patients. Three of four children with clinically overt seizures at presentation also had non-convulsive seizures on continuous EEG monitoring. Conclusions About one-fifth of children with acute AIS present with seizures. Seizures were always accompanied by focal neurologic deficits. Younger age was a risk factor for seizures at presentation. Seizure at presentation was not associated with infarct location or etiology. Non-convulsive seizures may occur during the acute period.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Seizures as a Presenting Symptom of Acute Arterial Ischemic Stroke in Childhood

Abend

Beslow

Smith

et al. 2011

The Journal of Pediatrics

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“…For instance, studies have suggested that Factor V Leiden and MTHFR mutations may be associated with increased risk of perinatal stroke[6–8]. On the other hand, a study examining polymorphisms of genes involved in the regulation of thrombosis and thrombolysis, and genes related to nitric oxide, cytokines, blood pressure control and cell adhesion did not find any differences in patients with perinatal arterial ischemic stroke compared to controls[5].…”

Section: Introductionmentioning

confidence: 99%

Genetic Risk Factors for Perinatal Arterial Ischemic Stroke

Gelfand

Croen

Torres

et al. 2013

Pediatric Neurology

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The cause of perinatal arterial ischemic stroke is unknown in most cases. We explored whether genetic polymorphisms modify the risk of perinatal arterial ischemic stroke. In a population-based case-control study of 1997–2002 births at Kaiser Permanente Northern California, we identified 13 white infants with perinatal arterial ischemic stroke. Controls included 86 randomly selected white infants. We genotyped polymorphisms in 9 genes involved in inflammation, thrombosis or lipid metabolism that have been previously linked with stroke, and compared genotype frequencies in case and control individuals. We tested the following polymorphisms: TNF-α-308, IL-6, lymphotoxin A, factor V Leiden, MTHFR 1298 and 667, prothrombin 20210, and apolipoprotein E ε2 and ε4 alleles. Patients with perinatal arterial ischemic stroke were more likely than controls to have at least one apolipoprotein E ε4 allele (54% vs. 25%, p=0.03). More patients with perinatal arterial ischemic stroke carried two ε4 alleles than did controls (15% vs. 2%, p=0.09), though this finding was not statistically significant. Proinflammatory and prothrombotic polymorphisms were not associated with perinatal arterial ischemic stroke in this small study. The apolipoprotein E polymorphism may confer genetic susceptibility for perinatal arterial ischemic stroke. Larger population-based studies are needed to confirm this finding.

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“…Studies have found variable conclusions related to age, with one of the more significant studies identifying an age less than 3 years as significantly associated with seizure [37]. Some studies have variably seen increased incidence of seizures in patients less than 1 year of age [41] or greater than 1 year of age [42], and yet others have failed to identify any significant difference between age groups.…”

Section: Risk Factors For Seizures In Pediatric Strokementioning

confidence: 95%