1
|
Das S, Ray BK, Mishra L, Chatterjee K, Mondal G, Paul DK. The Spectrum of Pediatric Infection-Associated Intracranial Arteriopathies and Acute Ischemic Stroke at 2 Eastern Indian Tertiary Care Centres. J Child Neurol 2023; 38:422-434. [PMID: 37138497 DOI: 10.1177/08830738231171800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Major and minor pediatric infections may cause intracranial arteriopathies, the long-term outcome of which we investigated and identified the factors influencing the progression/resolution of arteriopathies. METHODS We collected the clinical and radiological data of children aged 1 month-15 years who had ischemic stroke with definite arteriopathy following a recent febrile infection. Repeated neuroimaging was done over the next year to ascertain recurrent strokes and the progression and resolution of arteriopathies. RESULTS The anterior circulation was more frequently affected (83.33%), predominantly involving the middle cerebral artery (41.67%), resolving in 20.84% of cases and progressing in 33.33% of cases. Lesions were commonly unilateral (54.17%) and stenotic (75%), resulting predominantly in cortical infarcts (45.83%), with hemiparesis being the most common neurodeficiency. Apart from tubercular meningitis patients, others had a good functional outcome. CONCLUSION Lower age, minor infections, and unilateral arteriopathies had a significantly higher chance of resolution. Postviral arteriopathies had a significantly lower chance of progression compared with those following bacterial infections. Progressive and bilateral arteriopathies were significantly associated with worse outcomes and recurrent strokes.
Collapse
Affiliation(s)
- Suman Das
- Department of Neurology, North Bengal Medical College, Shusrutnagar, Darjeeling, West Bengal, India
| | - Biman Kanti Ray
- Department of Neurology, Bangur Institute of Neurology, Kolkata, West Bengal, India
| | | | - Kaushani Chatterjee
- Dr. B C Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| | - Gobinda Mondal
- Dr. B C Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| | - Dilip Kumar Paul
- Dr. B C Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| |
Collapse
|
2
|
Echizenya I, Tokairin K, Kawabori M, Kazumata K, Houkin K. Reversible Cerebral Angiopathy after Viral Infection in a Pediatric Patient with Genetic Variant of RNF213. J Stroke Cerebrovasc Dis 2019; 29:104549. [PMID: 31818681 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/29/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022] Open
Abstract
Ring finger protein (RNF) 213 is known as a susceptibility gene for moyamoya disease (MMD), which is characterized by bilateral carotid folk stenosis. Cerebral angiopathy after viral infection has been known to present angiographical appearance resembling MMD, however its pathogenesis and genetic background are not well known. We report a case of reversible cerebral angiopathy after viral infection in a pediatric patient with genetic variant of RNF213 mutation. The patient had developed a severe headache after hand, foot, and mouth disease. Magnetic resonance imaging and magnetic resonance angiography (MRA) performed 2-3 weeks after disease onset revealed bilateral carotid folk stenosis and an old cerebral infarction in the left putamen. The patient's headache spontaneously resolved and the follow-up MRA showed a complete spontaneous resolution of the arterial stenosis after 9 months. We were able to determine genetic predisposition to angiopathy by identifying the RNF213 c.14576G>A (rs112735431, p.R4859K) mutation. Based on the present case, we hypothesize that an RNF213 variant might play an important role for the onset of postviral cerebral angiopathy.
Collapse
Affiliation(s)
- Ikuma Echizenya
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kikutaro Tokairin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Masahito Kawabori
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ken Kazumata
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
3
|
Steinlin M, Bigi S, Stojanovski B, Gajera J, Regényi M, El-Koussy M, Mackay MT. Focal Cerebral Arteriopathy. Stroke 2017; 48:2375-2382. [DOI: 10.1161/strokeaha.117.016818] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/20/2017] [Accepted: 06/21/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Maja Steinlin
- From the Division of Child Neurology, Department of Pediatrics, University Children’s Hospital Bern, University of Bern, Switzerland (M.S., S.B., M.R.); Department of Neurology, Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute Melbourne, Parkville, Victoria, Australia (B.S., J.G., M.T.M.); Department of Neuroradiology, University Hospital and University of Bern, Switzerland (M.E.-K.); and the Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Sandra Bigi
- From the Division of Child Neurology, Department of Pediatrics, University Children’s Hospital Bern, University of Bern, Switzerland (M.S., S.B., M.R.); Department of Neurology, Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute Melbourne, Parkville, Victoria, Australia (B.S., J.G., M.T.M.); Department of Neuroradiology, University Hospital and University of Bern, Switzerland (M.E.-K.); and the Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Belinda Stojanovski
- From the Division of Child Neurology, Department of Pediatrics, University Children’s Hospital Bern, University of Bern, Switzerland (M.S., S.B., M.R.); Department of Neurology, Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute Melbourne, Parkville, Victoria, Australia (B.S., J.G., M.T.M.); Department of Neuroradiology, University Hospital and University of Bern, Switzerland (M.E.-K.); and the Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Jay Gajera
- From the Division of Child Neurology, Department of Pediatrics, University Children’s Hospital Bern, University of Bern, Switzerland (M.S., S.B., M.R.); Department of Neurology, Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute Melbourne, Parkville, Victoria, Australia (B.S., J.G., M.T.M.); Department of Neuroradiology, University Hospital and University of Bern, Switzerland (M.E.-K.); and the Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Maria Regényi
- From the Division of Child Neurology, Department of Pediatrics, University Children’s Hospital Bern, University of Bern, Switzerland (M.S., S.B., M.R.); Department of Neurology, Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute Melbourne, Parkville, Victoria, Australia (B.S., J.G., M.T.M.); Department of Neuroradiology, University Hospital and University of Bern, Switzerland (M.E.-K.); and the Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Marwan El-Koussy
- From the Division of Child Neurology, Department of Pediatrics, University Children’s Hospital Bern, University of Bern, Switzerland (M.S., S.B., M.R.); Department of Neurology, Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute Melbourne, Parkville, Victoria, Australia (B.S., J.G., M.T.M.); Department of Neuroradiology, University Hospital and University of Bern, Switzerland (M.E.-K.); and the Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Mark T. Mackay
- From the Division of Child Neurology, Department of Pediatrics, University Children’s Hospital Bern, University of Bern, Switzerland (M.S., S.B., M.R.); Department of Neurology, Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute Melbourne, Parkville, Victoria, Australia (B.S., J.G., M.T.M.); Department of Neuroradiology, University Hospital and University of Bern, Switzerland (M.E.-K.); and the Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
4
|
Tu Q, Cao H, Zhong W, Ding B, Tang X. Atorvastatin protects against cerebral ischemia/reperfusion injury through anti-inflammatory and antioxidant effects. Neural Regen Res 2014; 9:268-75. [PMID: 25206811 PMCID: PMC4146150 DOI: 10.4103/1673-5374.128220] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2013] [Indexed: 01/28/2023] Open
Abstract
In addition to its lipid-lowering effect, atorvastatin exerts anti-inflammatory and antioxidant effects as well. In this study, we hypothesized that atorvastatin could protect against cerebral ischemia/reperfusion injury. The middle cerebral artery ischemia/reperfusion model was established, and atorvastatin, 6.5 mg/kg, was administered by gavage. We found that, after cerebral ischemia/reperfusion injury, levels of the inflammation-related factors E-selectin and myeloperoxidase were upregulated, the oxidative stress-related marker malondialdehyde was increased, and superoxide dismutase activity was decreased in the ischemic cerebral cortex. Atorvastatin pretreatment significantly inhibited these changes. Our findings indicate that atorvastatin protects against cerebral ischemia/reperfusion injury through anti-inflammatory and antioxidant effects.
Collapse
Affiliation(s)
- Qiuyun Tu
- Department of Geriatrics, Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Hui Cao
- Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Wei Zhong
- Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Binrong Ding
- Department of Geriatrics, Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Xiangqi Tang
- Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| |
Collapse
|
5
|
Lyle CA, Bernard TJ, Goldenberg NA. Childhood arterial ischemic stroke: a review of etiologies, antithrombotic treatments, prognostic factors, and priorities for future research. Semin Thromb Hemost 2011; 37:786-93. [PMID: 22187401 DOI: 10.1055/s-0031-1297169] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Childhood arterial ischemic stroke (AIS) is a rare, but serious, medical condition, which is fatal in approximately 3% and associated with both acute and long-term neurologic impairment in over 70% of cases. Common etiologies include sickle cell disease, congenital heart disease, arterial dissection, prothrombotic conditions, and preceding viral infections; however, one in four cases is considered idiopathic. To date, no randomized controlled clinical trials (RCTs) have been conducted to establish evidence for current therapeutic strategies outside of sickle cell disease, thus, treatment strategies are largely shaped by consensus-based guidelines, in which, beyond the acute period, aspirin is the mainstay of therapy and anticoagulation is reserved for select circumstances. In recent years, evidence on prognostic factors has accumulated, helping to inform the future design of prognostically stratified RCTs. In this narrative review, we discuss the current understanding of etiologies, consensus-based treatment recommendations, contemporary treatment data, and prognostic factors in childhood AIS. We also identify priorities for future research.
Collapse
Affiliation(s)
- Courtney A Lyle
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Diego, California, USA.
| | | | | |
Collapse
|