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Childhood Stroke Often Has Multiple Causes

Laurie Barclay, MD

Nov. 15, 2002 — Strokes in children are rare, often have multiple causes, and have a different spectrum of risk factors than do strokes in adults, according to a report published online Nov. 15 in the Annals of Neurology. The investigators recommend a thorough evaluation seeking treatable causes to prevent recurrence.

"Our results confirm that rather than having a single cause, childhood stroke is a multifactorial process," lead author Vijeya Ganesan, MD, from the Institute of Child Health in London, U.K., says in a news release. "In contrast to some previous studies, completely unexplained stroke was rare if patients were evaluated in detail."

In this retrospective review of 212 pediatric patients who presented with a first arterial ischemic stroke, median age was five years, and 54% were male. As was found in earlier studies, about half (97 patients) had previous diagnoses of conditions predisposing to stroke, such as congenital heart disease or sickle cell disease. Among the remaining 115 patients who were healthy before stroke onset, 23 had a recent history of head trauma and 68 had had chickenpox. These conditions were significantly more common than in the group with previous diagnoses.

Cerebral arterial imaging was done in 185 patients (87%) and was abnormal in 79%. Abnormal imaging was significantly associated with systolic blood pressure greater than the 90th percentile, and there was a trend toward association with varicella infection in the previous year.

Treatable risk factors included anemia in 40% of patients, and elevated total plasma homocysteine or homozygosity for the t-MTHFR mutation in 21%. Of 104 echocardiograms in previously healthy patients, only eight were abnormal. Genetic or acquired conditions causing thrombophilia were also rare.

According to Dr. Ganesan, these findings suggest that all children who suffer stroke should have comprehensive evaluations, even if the cause of the stroke seems obvious.

"Risk factors for stroke in children are very different from those in adults. They do not include atherosclerosis, hypertension, or life style issues," says Gabrielle deVeber, MD, from the Hospital for Sick Children in Toronto, Canada. She is a pediatric stroke expert who was not affiliated with the study. "The study will help to sort out which risk factors are most common in children and should be investigated in patients following stroke. Future research will assess which treatments would help to prevent some or most of these risk factors."

Ann Neurol. November 15, 2002.
Reviewed by Gary D. Vogin, MD

Reprinted with Permission