title: Lack of progressive arteriopathy and stroke recurrence among children with cryptogenic stroke.
abstract: OBJECTIVE
  We hypothesized that cryptogenic forms of arterial ischemic stroke (AIS) in children may present better outcomes than symptomatic ones.
  
  
  METHODS
  We conducted a single-centered retrospective cohort study using chart reviews of all inpatients aged 0.25-16 years and admitted for AIS or TIA between 1994 and 2007. Sixty-three consecutive children with AIS were divided into 2 stroke categories: first, AIS with an established cause, considered as symptomatic (S), and second, AIS only associated with risk factors, and considered as cryptogenic (C). AIS were further subclassified according to the CASCADE stroke classification system. We measured long-term outcome with 2 endpoints: recurrence rate and neurologic impairment score (NIS). We used univariate analysis to compare the clinical and radiologic characteristics of both groups.
  
  
  RESULTS
  AIS were cryptogenic in 28 patients (44%) and symptomatic in 35 (56%). Compared to patients in group S, patients in group C showed an absence of stroke recurrence under prolonged aspirin treatment (0% vs 30.3%; p < 0.01), a predominance of nonprogressive arteriopathies (p = 0.02), unilateral infarcts (p = 0.01), M1 segment stenosis (p = 0.02), and better stroke outcomes (mean NIS 2.7 vs 4.2; p = 0.04). Within group C, patients with post-varicella arteriopathy (PVA) had a profile comparable to that of patients with non-PVA strokes in terms of infarct topography, localization of vascular lesions, recurrence rate, and neurologic outcome.
  
  
  CONCLUSIONS
  Cryptogenic AIS during childhood is a homogeneous clinical and radiologic entity, likely reflecting similar underlying pathophysiologic mechanisms. Under early and prolonged treatment with aspirin, cryptogenic AIS does not recur.
authors.affiliation: Neuropédiatrie, CHU Montpellier, Hôpital Gui de Chauliac, Montpellier, France. stefdart@gmail.com
authors.forename: Stephane
authors.initials: S
authors.lastname: Darteyre
authors.forename: Stephane
authors.initials: S
authors.lastname: Chabrier
authors.forename: Emilie
authors.initials: E
authors.lastname: Presles
authors.forename: Alain
authors.initials: A
authors.lastname: Bonafé
authors.forename: Agathe
authors.initials: A
authors.lastname: Roubertie
authors.forename: Bernard
authors.initials: B
authors.lastname: Echenne
authors.forename: Nicolas
authors.initials: N
authors.lastname: Leboucq
authors.forename: Francois
authors.initials: F
authors.lastname: Rivier
mesh_terms: D000293:Adolescent; D002545:Brain Ischemia / Q000209:etiology / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000473:pathology*