title: Stroke in children with cardiac disease: report from the International Pediatric Stroke Study Group Symposium.
abstract: BACKGROUND
  Cardiac disease is a leading cause of stroke in children, yet limited data support the current stroke prevention and treatment recommendations. A multidisciplinary panel of clinicians was convened in February 2014 by the International Pediatric Stroke Study group to identify knowledge gaps and prioritize clinical research efforts for children with cardiac disease and stroke.
  
  
  RESULTS
  Significant knowledge gaps exist, including a lack of data on stroke incidence, predictors, primary and secondary stroke prevention, hyperacute treatment, and outcome in children with cardiac disease. Commonly used diagnostic techniques including brain computed tomography and ultrasound have low rates of stroke detection, and diagnosis is frequently delayed. The challenges of research studies in this population include epidemiologic barriers to research such as small patient numbers, heterogeneity of cardiac disease, and coexistence of multiple risk factors. Based on stroke burden and study feasibility, studies involving mechanical circulatory support, single ventricle patients, early stroke detection strategies, and understanding secondary stroke risk factors and prevention are the highest research priorities over the next 5-10 years. The development of large-scale multicenter and multispecialty collaborative research is a critical next step. The designation of centers of expertise will assist in clinical care and research.
  
  
  CONCLUSIONS
  There is an urgent need for additional research to improve the quality of evidence in guideline recommendations for cardiogenic stroke in children. Although significant barriers to clinical research exist, multicenter and multispecialty collaboration is an important step toward advancing clinical care and research for children with cardiac disease and stroke.
authors.affiliation: Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Adriane J
authors.initials: AJ
authors.lastname: Sinclair
authors.affiliation: Department of Neurology, University of California, San Francisco, San Francisco, California.
authors.forename: Christine K
authors.initials: CK
authors.lastname: Fox
authors.affiliation: Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Rebecca N
authors.initials: RN
authors.lastname: Ichord
authors.affiliation: Department of Pediatrics, Stanford University, Lucile Packard Children's Hospital, Palo Alto, California.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Almond
authors.affiliation: Pediatrics, Neurology and Child Neurology, University of Colorado, Aurora, Colorado.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Bernard
authors.affiliation: Department of Pediatric Neurology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Beslow
authors.affiliation: Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Anthony K C
authors.initials: AK
authors.lastname: Chan
authors.affiliation: Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Cheung
authors.affiliation: Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: deVeber
authors.affiliation: Department of Pediatrics and Neurology, UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Dowling
authors.affiliation: Center for Pediatric Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Neil
authors.initials: N
authors.lastname: Friedman
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Therese M
authors.initials: TM
authors.lastname: Giglia
authors.affiliation: Division of Pediatric Neurology, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri; Division of Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Kristin P
authors.initials: KP
authors.lastname: Guilliams
authors.affiliation: Division of Cardiac Critical Care, Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Tilman
authors.initials: T
authors.lastname: Humpl
authors.affiliation: Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Licht
authors.affiliation: Department of Neurology, Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Mackay
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: lori.jordan@vanderbilt.edu.
authors.forename: Lori C
authors.initials: LC
authors.lastname: Jordan
mesh_terms: D002648:Child; D006331:Heart Diseases / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy
keywords: arterial ischemic; cardiac; congenital heart disease; stroke