Predictors of cerebral arteriopathy in children with arterial ischemic stroke: results of the International Pediatric Stroke Study.
BACKGROUND
Cerebral arteriopathies, including an idiopathic focal cerebral arteriopathy of childhood (FCA), are common in children with arterial ischemic stroke and strongly predictive of recurrence. To better understand these lesions, we measured predictors of arteriopathy within a large international series of children with arterial ischemic stroke.


RESULTS
Between January 2003 and July 2007, 30 centers within the International Pediatric Stroke Study enrolled 667 children (age, 29 days to 19 years) with arterial ischemic stroke 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 postvaricella angiopathy. We used multivariate logistic regression techniques to determine predictors of arteriopathy and FCA among those subjects who received vascular imaging. 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 to 9 years), recent upper respiratory infections, and sickle cell disease, whereas prior cardiac disease and sepsis reduced the risk of arteriopathy. The only predictor of FCA was recent upper respiratory infection.


CONCLUSIONS
Arteriopathy is prevalent among children with arterial ischemic stroke, particularly those presenting in early school age, and those with a history of sickle cell disease. Recent upper respiratory infection predicted cerebral arteriopathy and FCA in particular, suggesting a possible role for infection in the pathogenesis of these lesions.
Amlie-Lefond
Catherine
C
Department of Neurology, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, USA.
Bernard
Timothy J
TJ
Sébire
Guillaume
G
Friedman
Neil R
NR
Heyer
Geoffrey L
GL
Lerner
Norma B
NB
DeVeber
Gabrielle
G
Fullerton
Heather J
HJ
D000293:Adolescent; D017668:Age of Onset; D000755:Anemia, Sickle Cell / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D002539:Cerebral Arterial Diseases / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging / Q000379:methods / Q000706:statistics & numerical data; D042241:Early Diagnosis; D005260:Female; D014943:Global Health; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D020767:Intracranial Thrombosis / Q000150:complications / Q000453:epidemiology / Q000209:etiology; D008297:Male; D009072:Moyamoya Disease / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D012008:Recurrence; D012042:Registries; D012141:Respiratory Tract Infections / Q000150:complications / Q000175:diagnosis; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D013334:Students / Q000706:statistics & numerical data; D055815:Young Adult