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Risk factors for arterial ischemic stroke in children

Risk factors for arterial ischemic stroke in children
Risk factors for arterial ischemic stroke in children

Since early recurrence occurs in at least 10% of patients presenting with their first stroke in childhood in the reported series, the search for modifiable risk factors should be a priority. Risk factors for stroke in adults include hypertension, diabetes, and smoking, as well as cardiac disease and sickle cell anemia; asymptomatic cerebrovascular disease and transient ischemic events may predict stroke in this age group. The investigation of a child with a stroke has traditionally focused on finding a single cause rather than looking for risk factors to which the patient may be exposed life long. Approximately half of children presenting with stroke have a known predisposing condition, but some have unexpected pathologies such as primary cerebrovascular disease associated with congenital heart anomalies, or may have modifiable risk factors such as hypertension associated with sickle cell disease. The literature on children presenting with initially unexplained (cryptogenic) stroke suggests that there is a daunting list of possible causes, but since the series have mainly been small, it has been difficult to evaluate the relative importance of the reported associations. This paper reviews the literature on congenital, genetic, and acquired risk factors for stroke in childhood, and includes data from the large series of patients seen at Great Ormond Street Hospital over the past 10 years. The majority have arteriographic abnormalities and there is little evidence for asymptomatic cardiac disease. Genetic predisposition, trauma, infection, and nutritional deficiencies appear to be important, although case-control studies will be required to prove causation. Appropriate screening for modifiable risk factors may lead to prevention of recurrence in some patients. In the long term, an understanding of the multiple etiologies of childhood cerebrovascular disease and ischemic stroke may lead to primary prevention in this age group, and perhaps in adults.

0883-0738
299-307
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Prengler, Mara
6f2b4ccb-c630-406e-9df2-55147ccc7f5a
Hewes, Deborah K.M.
e7ddeb9b-911c-43a3-bac4-2ca9d32027ed
Ganesan, Vijeya
e3ae2ff5-0d89-43d2-8275-ba35b717149d
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Prengler, Mara
6f2b4ccb-c630-406e-9df2-55147ccc7f5a
Hewes, Deborah K.M.
e7ddeb9b-911c-43a3-bac4-2ca9d32027ed
Ganesan, Vijeya
e3ae2ff5-0d89-43d2-8275-ba35b717149d

Kirkham, Fenella J., Prengler, Mara, Hewes, Deborah K.M. and Ganesan, Vijeya (2000) Risk factors for arterial ischemic stroke in children. Journal of Child Neurology, 15 (5), 299-307. (doi:10.1177/088307380001500506).

Record type: Article

Abstract

Since early recurrence occurs in at least 10% of patients presenting with their first stroke in childhood in the reported series, the search for modifiable risk factors should be a priority. Risk factors for stroke in adults include hypertension, diabetes, and smoking, as well as cardiac disease and sickle cell anemia; asymptomatic cerebrovascular disease and transient ischemic events may predict stroke in this age group. The investigation of a child with a stroke has traditionally focused on finding a single cause rather than looking for risk factors to which the patient may be exposed life long. Approximately half of children presenting with stroke have a known predisposing condition, but some have unexpected pathologies such as primary cerebrovascular disease associated with congenital heart anomalies, or may have modifiable risk factors such as hypertension associated with sickle cell disease. The literature on children presenting with initially unexplained (cryptogenic) stroke suggests that there is a daunting list of possible causes, but since the series have mainly been small, it has been difficult to evaluate the relative importance of the reported associations. This paper reviews the literature on congenital, genetic, and acquired risk factors for stroke in childhood, and includes data from the large series of patients seen at Great Ormond Street Hospital over the past 10 years. The majority have arteriographic abnormalities and there is little evidence for asymptomatic cardiac disease. Genetic predisposition, trauma, infection, and nutritional deficiencies appear to be important, although case-control studies will be required to prove causation. Appropriate screening for modifiable risk factors may lead to prevention of recurrence in some patients. In the long term, an understanding of the multiple etiologies of childhood cerebrovascular disease and ischemic stroke may lead to primary prevention in this age group, and perhaps in adults.

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Published date: May 2000

Identifiers

Local EPrints ID: 429820
URI: http://eprints.soton.ac.uk/id/eprint/429820
ISSN: 0883-0738
PURE UUID: 677c0416-2609-4f64-9f47-30905a786890
ORCID for Fenella J. Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

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Date deposited: 05 Apr 2019 16:30
Last modified: 16 Mar 2024 03:22

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Contributors

Author: Mara Prengler
Author: Deborah K.M. Hewes
Author: Vijeya Ganesan

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