Faculty Collaboration Database

International Paediatric Stroke Study: stroke associated with cardiac disorders. Int J Stroke 2013 Oct;8 Suppl A100(Suppl A100):39-44

Date

12/13/2012

Pubmed ID

23231361

Pubmed Central ID

PMC4940849

DOI

10.1111/j.1747-4949.2012.00925.x

Scopus ID

2-s2.0-84886244152 (requires institutional sign-in at Scopus site)   69 Citations

Abstract

BACKGROUND AND HYPOTHESIS: The aetiologies of arterial ischaemic stroke in children are diverse and often multifactorial. A large proportion occurs in children with cardiac disorders. We hypothesized that the clinical and radiographic features of children with arterial ischaemic stroke attributed to cardiac disorders would differ from those with other causes.

METHODS: Using the large population collected in the prospective International Paediatric Stroke Study, we analysed the characteristics, clinical presentations, imaging findings, and early outcomes of children with and without cardiac disorders.

RESULTS: Aetiological data were available for 667 children with arterial ischaemic stroke (ages 29 days to 19 years). Cardiac disorders were indentified in 204/667 (30.6%), congenital defects in 121/204 (59.3%), acquired in 40/204 (19.6%), and isolated patent foramen ovale in 31/204 (15.2%). Compared to other children with stroke, those with cardiac disorders were younger (median age 3.1 vs. 6.5 years; P < 0.001) and less likely to present with headache (25.6% vs. 44.6%; P < 0.001), but were similar in terms of gender and presentation with focal deficits, seizures, or recent infection. Analysis of imaging data identified significant differences (P = 0.005) in the vascular distribution (anterior vs. posterior circulation or both) between groups. Bilateral strokes and haemorrhagic conversion were more prevalent in the cardiac disorders group.

CONCLUSIONS: Cardiac disorders were identified in almost one-third of children with arterial ischaemic stroke. They had similar clinical presentations to those without cardiac disorders but differed in age and headache prevalence. Children with cardiac disorders more frequently had a 'cardioembolic stroke pattern' with a higher prevalence of bilateral strokes in both the anterior and posterior circulations, and a greater tendency to haemorrhagic transformation.

Author List

Dowling MM, Hynan LS, Lo W, Licht DJ, McClure C, Yager JY, Dlamini N, Kirkham FJ, Deveber G, Pavlakis S, International Paediatric Stroke Study Group

MESH terms used to index this publication - Major topics in bold

Adolescent
Brain Ischemia
Child
Child, Preschool
Female
Headache Disorders
Heart Diseases
Humans
Infant
Magnetic Resonance Imaging
Male
Prognosis
Prospective Studies
Stroke
Tomography, X-Ray Computed
Young Adult