Hemorrhagic and ischemic stroke in children with cancer.
BACKGROUND
Adult survivors of childhood cancer have an increased risk of cerebrovascular disease; little is known about early stroke risk in childhood cancer. Our objectives were to assess stroke prevalence in children with cancer, to establish cancer and stroke type, and to determine if modifiable risk factors for stroke were present.


METHODS
Children with stroke and cancer were compared with all children seen for cancer at a single institution between 2000 and 2009. An International Classification of Disease, 9th version, code search and search of existing pediatric oncology and stroke databases identified children <18 years with ischemic stroke, intracerebral hemorrhage, and cerebral sinovenous thrombosis.


RESULTS
Of 1411 children with cancer, 15 had a stroke (1.1%, 95% CI: 0.6-1.7%). Stroke classifications were seven intracerebral hemorrhages, five ischemic strokes (one of which was followed by intracerebral hemorrhage), and three sinovenous thromboses. Stroke occurred at a median of 5 months after cancer diagnosis. Ten children with strokes had hematologic malignancies and five had brain tumors. Thirteen patients died poststroke, eight because of withdrawal of care. White blood cell count ≥48,000/mm3 was found in four children, all with intracerebral hemorrhage. Five of seven children with intracerebral hemorrhage had platelets <50,000/mm3.


CONCLUSIONS
Stroke has a prevalence of approximately 1% in children with cancer. Hemorrhagic stroke and ischemic stroke occur with approximately equal frequency; children with leukemia and brain tumors are at greatest risk.
Department of Anesthesia and Critical Care Medicine, Division of Pediatric ACCM, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: cnicule1@jhmi.edu.
Corina
C
Noje
Kenneth
K
Cohen
Lori C
LC
Jordan
D000293:Adolescent; D002545:Brain Ischemia / Q000175:diagnosis* / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology
brain tumors; leukemia; neurotoxicity of therapy; pediatric oncology; pediatric stroke