Characteristics of children with underlying cardiac defects who developed Arterial Ischaemic Stroke (IS)

Murugan, V. and Kirkham, F.J. (2008) Characteristics of children with underlying cardiac defects who developed Arterial Ischaemic Stroke (IS). Cerebrovascular Diseases, 25 (Supp. 2), p.98. (doi:10.1159/000132090).

Abstract

Background: Cardiac disease is a common underlying condition in children with arterial ischemic stroke (AIS). Embolism, dissection and moyamoya are recognised mechanisms and iron deficiency has been associated. However, few recent data exist relating the nature of the underlying cardiac defects, or associations withrecent investigational or surgical procedures
Objective: To investigate characteristics of children with underlying cardiac defects who developed AIS.
Method: Review of cardiac cases from Great Ormond Street first AIS cohort presenting 1978-2000.
Results: Of 212 with AIS, 33 (16%) children had underlying cardiac disease, with more boys (23; 70%). Median age at presentation was 4.7 (range 0.6-16.3) years. 17 (52%) developed stroke following cardiac surgery, 1 following catheterisation and15 (49%) spontaneously. 6 had another diagnosis (skin haemangioma, linear sebaceous naevus, Down syndrome, Williams syndrome, acute lympoblastic leukaemia and immunodeficiency).
The majority had right sided cerebral infarction (49%) followed by left side (30%) and bilateral (21%). Anterior (n=30) was commoner than posterior circulation involvement (n=3). Cerebral infarction was purely subcortical in 8, purely cortical in 7, and involved both cortical and subcortical tissue in 18 children. 20 (60%) had arterial imaging which showed occlusion in 7, stenosis in 4, dissection in 2, moyamoya in 2 and normal vessels in 5. 6 (16%) died following stroke, 6 (16%) had recurrent stroke, and 4 (11%) had further transient ischaemic attacks. Seven (21%) had iron deficiency.
Conclusion: Children with underlying cardiac defects comprised 1/6th of our AIS cohort; half had strokes spontaneously. Apparently primary cerebrovascular disease is as common as occlusion, presumably secondary to embolism. Iron deficiency was a risk factor in 1/5th but this and the other underlying diagnoses in addition to cardiac defects might increase the risk of developing AIS. This needs further investigation so that preventative strategies can be designed.

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Contributors

Author: F.J. Kirkham

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