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International paediatric stroke study: Stroke associated with cardiac disorders

International paediatric stroke study: Stroke associated with cardiac disorders
International paediatric stroke study: Stroke associated with cardiac disorders

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.

Arterial ischaemic stroke, Cardiac, Cardiac disorders, Cardioembolic stroke, Child neurology, Paediatric
1747-4930
39-44
Dowling, Michael M.
55720e49-d317-44bd-9cc6-8cc840232fe3
Hynan, Linda S.
cd29b38b-98d6-4ca3-b008-16d04246dee5
Lo, Warren
2eb9d14c-93a0-4851-9aa6-eb2c50cab93a
Licht, Daniel J.
2b6ccc71-e8f9-43b9-8986-6aca237a4a46
Mcclure, Chalmer
84faf9f9-4e04-4e95-9cce-53bca37d085e
Yager, Jerome Y.
49876493-abd6-46b8-a1dc-a01c9ee408af
Dlamini, Nomazulu
9d17b969-fd65-4620-888f-e54006d2e6dd
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
deVeber, Gabrielle
84ce8caa-ce30-4e50-b633-e5511c554e07
Pavlakis, Steve
b206b096-4124-4b41-9e46-48edff64a050
Dowling, Michael M.
55720e49-d317-44bd-9cc6-8cc840232fe3
Hynan, Linda S.
cd29b38b-98d6-4ca3-b008-16d04246dee5
Lo, Warren
2eb9d14c-93a0-4851-9aa6-eb2c50cab93a
Licht, Daniel J.
2b6ccc71-e8f9-43b9-8986-6aca237a4a46
Mcclure, Chalmer
84faf9f9-4e04-4e95-9cce-53bca37d085e
Yager, Jerome Y.
49876493-abd6-46b8-a1dc-a01c9ee408af
Dlamini, Nomazulu
9d17b969-fd65-4620-888f-e54006d2e6dd
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
deVeber, Gabrielle
84ce8caa-ce30-4e50-b633-e5511c554e07
Pavlakis, Steve
b206b096-4124-4b41-9e46-48edff64a050

Dowling, Michael M., Hynan, Linda S., Lo, Warren, Licht, Daniel J., Mcclure, Chalmer, Yager, Jerome Y., Dlamini, Nomazulu, Kirkham, Fenella J., deVeber, Gabrielle and Pavlakis, Steve (2013) International paediatric stroke study: Stroke associated with cardiac disorders. International Journal of Stroke, 8 (100 A), 39-44. (doi:10.1111/j.1747-4949.2012.00925.x).

Record type: Article

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.

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More information

Published date: 2013
Keywords: Arterial ischaemic stroke, Cardiac, Cardiac disorders, Cardioembolic stroke, Child neurology, Paediatric

Identifiers

Local EPrints ID: 424263
URI: http://eprints.soton.ac.uk/id/eprint/424263
ISSN: 1747-4930
PURE UUID: efc9225a-7d95-40ba-8c67-15e69c3aaaea
ORCID for Fenella J. Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

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Date deposited: 05 Oct 2018 11:35
Last modified: 16 Mar 2024 03:22

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Contributors

Author: Michael M. Dowling
Author: Linda S. Hynan
Author: Warren Lo
Author: Daniel J. Licht
Author: Chalmer Mcclure
Author: Jerome Y. Yager
Author: Nomazulu Dlamini
Author: Gabrielle deVeber
Author: Steve Pavlakis

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