1
|
Das S, Ray BK, Nandi M, Mondal G, Paul DK. The Spectrum of Intracranial Arteriopathies and Ischemic Strokes in Pediatric Tubercular Meningitis: A Tricentric Study From Eastern India. Pediatr Neurol 2024; 157:57-69. [PMID: 38878674 DOI: 10.1016/j.pediatrneurol.2024.04.026] [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] [Received: 03/09/2024] [Revised: 04/11/2024] [Accepted: 04/28/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Addressing the need to uniformly classify arteriopathies among patients with arterial ischemic stroke (AIS) due to tubercular meningitis (TBM), we used the Childhood AIS Standardised Classification and Diagnostic Evaluation (CASCADE) criteria. METHODS This tri-centric prospective study included children aged 0.5-12 years with TBM and AIS. Magnetic resonance angiographies (MRAs) were done during admission and repeated 3 and 12 months after discharge. Arteriopathies were classified according to the primary CASCADE criteria. We used the modified Pediatric Alberta Stroke Programme Early Computed Tomography Score as an ordinal measure of infarct volume. The severity of arteriopathies was graded using the focal cerebral arteriopathy severity score (FCASS). The final outcomes were measured at the 12-month follow-up visit using the Pediatric Stroke Outcome Measure (PSOM). RESULTS Out of 55 patients, 64% had MRA-evidenced arteriopathies and 84% had multiple infarcts. The middle cerebral (46%) and internal carotid arteries (22%) were most commonly affected. The basal ganglia (70%) and the cerebral cortex (61%) were most commonly infarcted. CASCADE categories included 3b (40%), 1d (38%), 2b (16%), 2c (5%), progressive (32%), and stable (44%) arteriopathies. Younger age, hypertrophic pachymeningitis, cortical infarcts, recurrent strokes, progressive arteriopathies, EEG abnormalities, and mortality were significantly higher among patients with MRA-proven arteriopathies. Patients with progressive arteriopathies had a significantly higher prevalence of hypertrophic pachymeningitis, cortical infarcts, and recurrent strokes. FCASS correlated positively with outcomes measured by the Pediatric Stroke Outcome Measure and modified Pediatric Alberta Stroke Programme Early Computed Tomography Score. CONCLUSION The CASCADE classification clarified the arteriopathy patterns, enabling us to correlate them with the characteristics of the infarcts. FCASS is useful to grade the arteriopathy severity and progression in TBM.
Collapse
Affiliation(s)
- Suman Das
- Department of Neurology, North Bengal Medical College, Siliguri, West Bengal, India.
| | - Biman Kanti Ray
- Department of Neurology, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Madhumita Nandi
- Department of Pediatric Medicine, North Bengal Medical College, Siliguri, West Bengal, India
| | - Gobinda Mondal
- Department of Pediatric Medicine, Dr. B C Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| | - Dilip Kumar Paul
- Department of Pediatric Medicine, Dr. B C Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| |
Collapse
|
2
|
Pai AM, To T, deVeber GA, Nichol D, Kassner A, Ertl-Wagner B, Rafay MF, Dlamini N. Health Inequity and Time From Pediatric Stroke Onset to Arrival. Stroke 2024; 55:1299-1307. [PMID: 38488379 DOI: 10.1161/strokeaha.123.045411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/06/2024] [Indexed: 04/24/2024]
Abstract
BACKGROUND Time from stroke onset to hospital arrival determines treatment and impacts outcome. Structural, socioeconomic, and environmental factors are associated with health inequity and onset-to-arrival in adult stroke. We aimed to assess the association between health inequity and onset-to-arrival in a pediatric comprehensive stroke center. METHODS A retrospective observational study was conducted on a consecutive cohort of children (>28 days-18 years) diagnosed with acute arterial ischemic stroke (AIS) between 2004 and 2019. Neighborhood-level material deprivation was derived from residential postal codes and used as a proxy measure for health inequity. Patients were stratified by level of neighborhood-level material deprivation, and onset-to-arrival was categorized into 3 groups: <6, 6 to 24, and >24 hours. Association between neighborhood-level material deprivation and onset-to-arrival was assessed in multivariable ordinal logistic regression analyses adjusting for sociodemographic and clinical factors. RESULTS Two hundred and twenty-nine children were included (61% male; median age [interquartile range] at stroke diagnosis 5.8-years [1.1-11.3]). Over the 16-year study period, there was an increase in proportion of children diagnosed with AIS living in the most deprived neighborhoods and arriving at the emergency room within 6 hours (P=0.01). Among Asian patients, a higher proportion lived in the most deprived neighborhoods (P=0.02) and level of material deprivation was associated with AIS risk factors (P=0.001). CONCLUSIONS Our study suggests an increase in pediatric stroke in deprived neighborhoods and certain communities, and earlier arrival times to the emergency room over time. However, whether these changes are due to an increase in incidence of childhood AIS or increased awareness and diagnosis is yet to be determined. The association between AIS risk factors and material deprivation highlights the intersectionality of clinical factors and social determinants of health. Finally, whether material deprivation impacts onset-to-arrival is likely complex and requires further examination.
Collapse
Affiliation(s)
- Akshat M Pai
- Division of Neurology (A.M.P., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada
- Child Health Evaluative Sciences Program, Research Institute (A.M.P., T.T., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada
- Institute of Medical Science (A.M.P., T.T., G.A.V., A.K., N.D.), University of Toronto, Canada
| | - Teresa To
- Child Health Evaluative Sciences Program, Research Institute (A.M.P., T.T., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada
- Institute of Medical Science (A.M.P., T.T., G.A.V., A.K., N.D.), University of Toronto, Canada
- Dalla Lana School of Public Health (T.T.), University of Toronto, Canada
| | - Gabrielle A deVeber
- Division of Neurology (A.M.P., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada
- Child Health Evaluative Sciences Program, Research Institute (A.M.P., T.T., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada
- Institute of Medical Science (A.M.P., T.T., G.A.V., A.K., N.D.), University of Toronto, Canada
| | - Daniel Nichol
- Neurosciences & Mental Health Program, Research Institute (D.N., N.D.), The Hospital for Sick Children, Toronto, Canada
| | - Andrea Kassner
- Division of Translational Medicine (A.K.), The Hospital for Sick Children, Toronto, Canada
- Institute of Medical Science (A.M.P., T.T., G.A.V., A.K., N.D.), University of Toronto, Canada
- Department of Medical Imaging (A.K., B.E.-W.), University of Toronto, Canada
| | - Birgit Ertl-Wagner
- and Division of Neuroradiology (B.E.-W.), The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging (A.K., B.E.-W.), University of Toronto, Canada
| | - Mubeen F Rafay
- Section of Pediatric Neurology, Department of Pediatric and Child Health, University of Manitoba, Winnipeg, Canada (M.F.R.)
| | - Nomazulu Dlamini
- Division of Neurology (A.M.P., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada
- Child Health Evaluative Sciences Program, Research Institute (A.M.P., T.T., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada
- Neurosciences & Mental Health Program, Research Institute (D.N., N.D.), The Hospital for Sick Children, Toronto, Canada
- Institute of Medical Science (A.M.P., T.T., G.A.V., A.K., N.D.), University of Toronto, Canada
| |
Collapse
|
3
|
Little SB, Sarma A, Bajaj M, Pruthi S, Reddy K, Reisner A, Philbrook B, Jordan LC. Imaging of Vertebral Artery Dissection in Children: An Underrecognized Condition with High Risk of Recurrent Stroke. Radiographics 2023; 43:e230107. [PMID: 37971932 DOI: 10.1148/rg.230107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Vertebral artery dissection (VAD) is a common cause of a rare condition, pediatric posterior circulation arterial ischemic stroke (PCAIS). VAD is clinically important due to the risk of multifocal and continuing infarcts from artery-to-artery thromboembolism, with the potential for occlusion of arteries that perfuse the brainstem. Early diagnosis is important, as recurrent stroke is a common effect of VAD in children. Although the relative efficacies of different treatment regimens for VAD in children remain unsettled, early initiation of treatment can mitigate the risk of delayed stroke. Clinical diagnosis of PCAIS may be delayed due to multiple factors, including nonspecific symptoms and the inability of younger patients to express symptoms. In fact, subacute or chronic infarcts are often present at initial imaging. Although the most common cause of isolated PCAIS is VAD, imaging of the cervical arteries has been historically underused in this setting. Cervical vascular imaging (MR angiography, CT angiography, and digital subtraction angiography) for VAD must be optimized to detect the sometimes subtle findings, which may be identified at initial or follow-up imaging. Osseous variants of the craniocervical junction and upper cervical spine and other extrinsic lesions that may directly injure the vertebral arteries or lead to altered biomechanics have been implicated in some cases. The authors review characteristic imaging features and optimized imaging of VAD and associated PCAIS and related clinical considerations. Identification of VAD has important implications for evaluation, treatment, and imaging follow-up, as this condition may result in progressive arteriopathy and recurrent stroke. © RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
Collapse
Affiliation(s)
- Stephen B Little
- From the Departments of Radiology (S.B.L., M.B., K.R.), Neurosurgery and Pediatrics (A.R.), and Pediatrics-Child Neurology (B.P.), Children's Healthcare of Atlanta, Emory University, Atlanta, GA; and Departments of Radiology (A.S., S.P.) and Pediatrics (L.C.J.), Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323
| | - Asha Sarma
- From the Departments of Radiology (S.B.L., M.B., K.R.), Neurosurgery and Pediatrics (A.R.), and Pediatrics-Child Neurology (B.P.), Children's Healthcare of Atlanta, Emory University, Atlanta, GA; and Departments of Radiology (A.S., S.P.) and Pediatrics (L.C.J.), Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323
| | - Manish Bajaj
- From the Departments of Radiology (S.B.L., M.B., K.R.), Neurosurgery and Pediatrics (A.R.), and Pediatrics-Child Neurology (B.P.), Children's Healthcare of Atlanta, Emory University, Atlanta, GA; and Departments of Radiology (A.S., S.P.) and Pediatrics (L.C.J.), Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323
| | - Sumit Pruthi
- From the Departments of Radiology (S.B.L., M.B., K.R.), Neurosurgery and Pediatrics (A.R.), and Pediatrics-Child Neurology (B.P.), Children's Healthcare of Atlanta, Emory University, Atlanta, GA; and Departments of Radiology (A.S., S.P.) and Pediatrics (L.C.J.), Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323
| | - Kartik Reddy
- From the Departments of Radiology (S.B.L., M.B., K.R.), Neurosurgery and Pediatrics (A.R.), and Pediatrics-Child Neurology (B.P.), Children's Healthcare of Atlanta, Emory University, Atlanta, GA; and Departments of Radiology (A.S., S.P.) and Pediatrics (L.C.J.), Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323
| | - Andrew Reisner
- From the Departments of Radiology (S.B.L., M.B., K.R.), Neurosurgery and Pediatrics (A.R.), and Pediatrics-Child Neurology (B.P.), Children's Healthcare of Atlanta, Emory University, Atlanta, GA; and Departments of Radiology (A.S., S.P.) and Pediatrics (L.C.J.), Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323
| | - Bryan Philbrook
- From the Departments of Radiology (S.B.L., M.B., K.R.), Neurosurgery and Pediatrics (A.R.), and Pediatrics-Child Neurology (B.P.), Children's Healthcare of Atlanta, Emory University, Atlanta, GA; and Departments of Radiology (A.S., S.P.) and Pediatrics (L.C.J.), Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323
| | - Lori C Jordan
- From the Departments of Radiology (S.B.L., M.B., K.R.), Neurosurgery and Pediatrics (A.R.), and Pediatrics-Child Neurology (B.P.), Children's Healthcare of Atlanta, Emory University, Atlanta, GA; and Departments of Radiology (A.S., S.P.) and Pediatrics (L.C.J.), Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323
| |
Collapse
|
4
|
Carlhan-Ledermann A, Bartoli A, Gebistorf F, Beghetti M, Sologashvili T, Rebollo Polo M, Fluss J. Decompressive hemicraniectomy in pediatric malignant arterial ischemic stroke: a case-based review. Childs Nerv Syst 2023; 39:2377-2389. [PMID: 37493722 PMCID: PMC10432330 DOI: 10.1007/s00381-023-06086-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/15/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE Malignant stroke is a life-threatening emergency, with a high mortality rate (1-3). Despite strong evidence showing decreased morbidity and mortality in the adult population, decompressive hemicraniectomy (DCH) has been scarcely reported in the pediatric stroke population, and its indication remains controversial, while it could be a potential lifesaving option. METHODS AND RESULTS We performed an extensive literature review on pediatric malignant arterial ischemic stroke (pmAIS) and selected 26 articles reporting 97 cases. Gathering the data together, a 67% mortality rate is observed without decompressive therapy, contrasting with a 95.4% survival rate with it. The median modified Rankin score (mRS) is 2.1 after surgery with a mean follow-up of 31.8 months. For the 33% of children who survived without surgery, the mRS is 3 at a mean follow-up of 19 months. As an illustrative case, we report on a 2-year-old girl who presented a cardioembolic right middle cerebral artery stroke with subsequent malignant edema and ongoing cerebral transtentorial herniation in the course of a severe myocarditis requiring ECMO support. A DCH was done 32 h after symptom onset. At the age of 5 years, she exhibits an mRS of 3. CONCLUSION Pediatric stroke with malignant edema is a severe condition with high mortality rate if left untreated and often long-lasting consequences. DCH might minimize the vicious circle of cerebral swelling, increasing intracranial pressure and brain ischemia. Our literature review underscores DCH as an efficient therapeutic measure management of pmAIS even when performed after a significant delay; however, long-lasting morbidities remain high.
Collapse
Affiliation(s)
- Audrey Carlhan-Ledermann
- Neonatology and Pediatric Intensive Care Unit, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Andrea Bartoli
- Neurosurgery Unit, Department of Clinical Neuroscience, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Fabienne Gebistorf
- Neonatology and Pediatric Intensive Care Unit, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Maurice Beghetti
- Pediatric Cardiology Unit, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Tornike Sologashvili
- Cardiovascular Surgery Unit, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Monica Rebollo Polo
- Pediatric Radiology Unit, Department of Radiology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Joel Fluss
- Pediatric Neurology Unit, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| |
Collapse
|
5
|
Lee S, Mlynash M, Christensen S, Jiang B, Wintermark M, Sträter R, Broocks G, Grams A, Nikoubashman O, Morotti A, Trenkler J, Möhlenbruch M, Fiehler J, Wildgruber M, Kemmling A, Psychogios M, Sporns PB. Hyperacute Perfusion Imaging Before Pediatric Thrombectomy: Analysis of the Save ChildS Study. Neurology 2023; 100:e1148-e1158. [PMID: 36543574 PMCID: PMC10074461 DOI: 10.1212/wnl.0000000000201687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/27/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Perfusion imaging can identify adult patients with salvageable brain tissue who would benefit from thrombectomy in later time windows. The feasibility of obtaining hyperacute perfusion sequences in pediatric stroke is unknown. The aim of this study was to determine whether contrast perfusion imaging delayed time to treatment and to assess perfusion profiles in children with large vessel occlusion stroke. METHODS The Save ChildS retrospective cohort study (January 2000-December 2018) enrolled children (1 month-18 years) with stroke who underwent thrombectomy from 27 European and U.S. stroke centers. This secondary analysis included patients with anterior circulation occlusion and available imaging for direct review by the neuroimaging core laboratory. Between-group comparisons were performed using the Wilcoxon rank-sum exact test for continuous variables or Fisher exact test for binary variables. Given the small number of patients, evaluation of perfusion imaging parameters was performed descriptively only. RESULTS Of 33 patients with available neuroimaging, 15 (45.4%) underwent perfusion (CT perfusion n = 6; MR perfusion n = 9); all were technically adequate. The median time from onset to recanalization did not differ between groups {4 hours (interquartile range [IQR] 4-7.5) perfusion+; 3.4 hours (IQR 2.5-6.5) perfusion-, p = 0.158}. Target mismatch criteria were met by 10/15 (66.7%) patients and did not correlate with reperfusion status or functional outcome. The hypoperfusion intensity ratio (HIR) was favorable in 11/15 patients and correlated with older age but not NIHSS, time to recanalization, or stroke etiology. Favorable HIR was associated with better functional outcome at 6 months (Pediatric Stroke Outcome Measure 1.0 [IQR 0.5-2.0] vs 2.0 [1.5-3.0], p = 0.026) and modified Rankin Scale 1.0 [0-1] vs 2.0 [1.5-3.5], p = 0.048) in this small sample. DISCUSSION Automated perfusion imaging is feasible to obtain acutely in children and does not delay time to recanalization. Larger prospective studies are needed to determine biomarkers of favorable outcome in pediatric ischemic stroke and to establish core and penumbral thresholds in children.
Collapse
Affiliation(s)
- Sarah Lee
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland.
| | - Michael Mlynash
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Soren Christensen
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Bin Jiang
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Max Wintermark
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Ronald Sträter
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Gabriel Broocks
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Astrid Grams
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Omid Nikoubashman
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Andrea Morotti
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Johannes Trenkler
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Markus Möhlenbruch
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Jens Fiehler
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Moritz Wildgruber
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Andre Kemmling
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Marios Psychogios
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Peter B Sporns
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| |
Collapse
|
6
|
Aprasidze T, Shatirishvili T, Oesch G, Lomidze G, Tatishvili N. Outcome in Childhood Stroke: Comparing Functional Outcome by Modified Rankin Scale with Neurological Outcome by Pediatric Stroke Outcome Measure. JOURNAL OF PEDIATRIC NEUROLOGY 2023. [DOI: 10.1055/s-0043-1761620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
AbstractDifferent scales are used as outcome predictors following arterial ischemic stroke (AIS) in children. Pediatric stroke outcome measure (PSOM) gives information about neurological deficits and function and modified Rankin scale (mRS) about functional outcome. Research examining the relationship between the two measures is scarce. The aim of this study is to correlate the two different scales and to get some information on the long course of outcomes according to these outcome measures. Sixty-one children with the diagnosis of AIS and normal neurodevelopment prior to stroke were investigated. Results of outcome measures (PSOM and mRS) from ≥ 2 years of follow-up were analyzed. Changes of neurological deficits (subcategories of PSOM) over time (discharge, 6 months, and ≥2 years) and prognostic impact on the outcome of the Pediatric National Institutes of Health Stroke Scale and etiology/risk factors are presented.Cramer's V with a coefficient of 0.836 (df-1) indicates a strong association between dichotomized total PSOM and mRS scores. The correlation between the total scales was strong (rho = 0.983, p < 0.001). The correlation coefficient was highest for sensorimotor (rho = 0.949, p < 0.001), then for language (rho = 0.464, p < 0.001) and cognitive (rho = 0.363, p = 0.004) subscales. PSOM scores improved at 6 months compared to the discharge state in sensorimotor (p<0.001) and language (p<0.026) domains, however, there was no statistically significant difference between PSOM scores at 6 months and >2 years follow-up. There was no improvement in cognitive PSOM scores during the follow-up period.There was a high concordance level between the two scales, illustrating that long-term neurological deficits after stroke are related to poor functional outcome. Significant improvement of sensorimotor and language function happened within the period from onset to 6 months of follow-up. Thus, early mobilization of appropriate rehabilitative therapy might improve the outcome. We conclude that both outcome classifications are applicable for assessing outcome after childhood AIS.
Collapse
Affiliation(s)
- Tatia Aprasidze
- Department of Neurology, David Tvildiani Medical University, Tbilisi, Georgia
- Department of Neuroscience, M. Iashvili Children's Central Hospital, Tbilisi, Georgia
| | - Teona Shatirishvili
- Department of Neurology, David Tvildiani Medical University, Tbilisi, Georgia
- Department of Neuroscience, M. Iashvili Children's Central Hospital, Tbilisi, Georgia
| | - Gabriela Oesch
- Division of Child Neurology, Department of Pediatrics, University Children's Hospital Bern, University of Bern, Bern, Switzerland
| | - Giorgi Lomidze
- Department of Neurology, European University, Tbilisi, Georgia
| | - Nana Tatishvili
- Department of Neurology, David Tvildiani Medical University, Tbilisi, Georgia
- Department of Neuroscience, M. Iashvili Children's Central Hospital, Tbilisi, Georgia
| |
Collapse
|
7
|
Baggio L, Nosadini M, Pelizza MF, Pin JN, Zarpellon A, Tona C, Perilongo G, Simioni P, Toldo I, Talenti G, Sartori S. Neonatal Arterial Ischemic Stroke Secondary to Carotid Artery Dissection: A Case Report and Systematic Literature Review. Pediatr Neurol 2023; 139:13-21. [PMID: 36502767 DOI: 10.1016/j.pediatrneurol.2022.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/01/2022] [Accepted: 10/23/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Carotid artery (CA) dissection is a rare etiology of neonatal arterial ischemic stroke (NAIS). METHODS We describe one novel case and conduct a systematic literature review on NAIS attributed to CA dissection, to collect data on its clinical-radiological presentation, treatment, and outcome. RESULTS Eight published cases of NAIS attributed to CA dissection were identified and analyzed with our case. All patients (nine of nine) were born at term, and eight of nine experienced instrumental/traumatic delivery or urgent Caesarean section. None had fetal problems during pregnancy or thrombophilia. Signs and symptoms at presentation (between days of life 0 and 6) included seizures (eight of nine), respiratory distress or irregular breathing (five of nine), hyporeactivity, decreased consciousness or irritability (four of nine), and focal neurological signs (two of nine). At magnetic resonance imaging (MRI), stroke was unilateral in seven of nine and extensive in five of nine. CA dissection was documented by neuroimaging or at postmortem studies (seven of nine), and hypothesized by the treating physicians based on delivery and neuroradiology characteristics (in the remaining two of nine). Antithrombotic treatment was used in two of nine. According to available follow-up, one of eight died at age seven days, seven of eight had neurological/epileptic sequelae, and CA recanalization occurred in three of four. CONCLUSIONS NAIS attributed to CA dissection is rarely identified in the literature, often preceded by traumatic/instrumental delivery, presenting with seizures and systemic signs/symptoms, and often characterized by extensive MRI lesions and neurological sequelae. Definite evidence and recommendations on antithrombotic treatment are lacking.
Collapse
Affiliation(s)
- Laura Baggio
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy; Master in Pediatrics and Pediatric Subspecialties, University of Padova, Padova, Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy; Neuroimmunology group, Paediatric Research Institute "Città della Speranza", Padova, Italy.
| | - Maria Federica Pelizza
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Jacopo Norberto Pin
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Anna Zarpellon
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Clarissa Tona
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Giorgio Perilongo
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Paolo Simioni
- General Internal Medicine and Thrombotic and Hemorrhagic Unit, University of Padua, Padua, Italy
| | - Irene Toldo
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Giacomo Talenti
- Neuroradiology Unit, University Hospital of Padova, Padova, Italy
| | - Stefano Sartori
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy; Neuroimmunology group, Paediatric Research Institute "Città della Speranza", Padova, Italy; Department of Neuroscience, University of Padova, Padova, Italy
| |
Collapse
|
8
|
Amlie-Lefond C. Pediatric Stroke-Are We Asking the Right Questions? The 2022 Sidney Carter Award Lecture. Neurology 2023; 100:192-198. [PMID: 36347625 DOI: 10.1212/wnl.0000000000201487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/14/2022] [Indexed: 11/11/2022] Open
Abstract
Over the past few decades, robust clinical and research collaborations among pediatric stroke researchers have informed and improved the care of children with stroke. Risk factors and presentation of childhood stroke have been described, and the acute and chronic burden of childhood stroke has been better delineated. Nevertheless, high-quality data for the treatment of children with stroke is dwarfed by that available for adult stroke, and it is therefore tempting to extend research questions and treatment trials from adults to children. A trial designed to answer a question about stroke in adults may yield useful information about stroke in childhood, but a trial that incorporates the unique neurodevelopmental and etiologic aspects of childhood stroke is more likely to truly advance care. Research questions and study design in childhood stroke must capture the complexity of stroke mechanisms and medical comorbidities in children who suffer stroke, the impact on the developing nervous system, and the role of normal and aberrant neurodevelopment in recovery.
Collapse
Affiliation(s)
- Catherine Amlie-Lefond
- From the Department of Neurology and Department of Neurosurgery, University of Washington, Seattle, WA.
| |
Collapse
|
9
|
Younger DS. Motor sequela of adult and pediatric stroke: Imminent losses and ultimate gains. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:305-346. [PMID: 37620077 DOI: 10.1016/b978-0-323-98817-9.00025-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Stroke is the leading cause of neurological disability in the United States and worldwide. Remarkable advances have been made over the past 20 years in acute vascular treatments to reduce infarct size and improve neurological outcome. Substantially less progress has been made in the understanding and clinical approaches to neurological recovery after stroke. This chapter reviews the epidemiology, bedside examination, localization approaches, and classification of stroke, with an emphasis on motor stroke presentations and management, and promising research approaches to enhancing motor aspects of stroke recovery.
Collapse
Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
| |
Collapse
|
10
|
Silva AHD, Bhate S, Ganesan V, Thompson D, James G. Surgical revascularization for pediatric moyamoya: the role of surgical mentorship in sustaining and developing a neurovascular service. J Neurosurg Pediatr 2022; 30:89-98. [PMID: 36303484 DOI: 10.3171/2022.3.peds21590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/31/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Obtaining operative experience for the treatment of rare conditions in children represents a challenge for pediatric neurosurgeons. Starting in November 2017, a surgeon was mentored in surgical revascularization (SR) for pediatric moyamoya with a view to service development and sustainability. The aim of this audit was to evaluate early outcomes of SR for pediatric moyamoya during and following a surgical mentorship. METHODS A retrospective cohort study with chart/database review of consecutive moyamoya surgeries performed by a new attending surgeon (between November 2017 and March 2020) was compared to a previously published cohort from the authors' institution in terms of clinical and angiographic outcomes, complications, operating time, and length of stay. A standardized technique of encephaloduroarteriomyosynangiosis with the superficial temporal artery was used. RESULTS Twenty-two children underwent 36 indirect SRs during the study period. Patient demographics were similar between cohorts. The first group of 6 patients had 11 SRs performed jointly by the new attending surgeon mentored by an established senior surgeon (group A), followed by 10 patients with 16 SRs performed independently by the new attending surgeon (group B). The last 6 patients had 9 SRs with the new attending surgeon mentoring a senior fellow (group C) in performing SR. Good angiographic collateralization (Matsushima grades A and B) was observed in 80% of patients, with similar proportions across all 3 groups. A total of 18/19 symptomatic patients (95%) derived symptomatic benefit. There was no perioperative death and, compared to the historical cohort, a similar proportion had a recurrent arterial ischemic event (i.e., acute ischemic stroke) necessitating a second SR (1/22 vs 3/73). Operative times were longest in group C, with no difference in length of hospital stay among the 3 groups. CONCLUSIONS Early outcomes demonstrate the feasibility of mentorship for safely incorporating new neurosurgeons in sustaining and developing a tertiary-level surgical service.
Collapse
Affiliation(s)
- Adikarige Haritha Dulanka Silva
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust.,3Great Ormond Street Institute of Child Health, University College London, United Kingdom
| | - Sanjay Bhate
- 2Department of Paediatric Neurology, Great Ormond Street Hospital for Children NHS Foundation Trust; and.,3Great Ormond Street Institute of Child Health, University College London, United Kingdom
| | - Vijeya Ganesan
- 2Department of Paediatric Neurology, Great Ormond Street Hospital for Children NHS Foundation Trust; and.,3Great Ormond Street Institute of Child Health, University College London, United Kingdom
| | - Dominic Thompson
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust.,3Great Ormond Street Institute of Child Health, University College London, United Kingdom
| | - Greg James
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust.,3Great Ormond Street Institute of Child Health, University College London, United Kingdom
| |
Collapse
|
11
|
Sporns PB, Fullerton HJ, Lee S, Kim H, Lo WD, Mackay MT, Wildgruber M. Childhood stroke. Nat Rev Dis Primers 2022; 8:12. [PMID: 35210461 DOI: 10.1038/s41572-022-00337-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 01/09/2023]
Abstract
Stroke is an important cause of neurological morbidity in children; most survivors have permanent neurological deficits that affect the remainder of their life. Stroke in childhood, the focus of this Primer, is distinguished from perinatal stroke, defined as stroke before 29 days of age, because of its unique pathogenesis reflecting the maternal-fetal unit. Although approximately 15% of strokes in adults are haemorrhagic, half of incident strokes in children are haemorrhagic and half are ischaemic. The causes of childhood stroke are distinct from those in adults. Urgent brain imaging is essential to confirm the stroke diagnosis and guide decisions about hyperacute therapies. Secondary stroke prevention strongly depends on the underlying aetiology. While the past decade has seen substantial advances in paediatric stroke research, the quality of evidence for interventions, such as the rapid reperfusion therapies that have revolutionized arterial ischaemic stroke care in adults, remains low. Substantial time delays in diagnosis and treatment continue to challenge best possible care. Effective primary stroke prevention strategies in children with sickle cell disease represent a major success, yet barriers to implementation persist. The multidisciplinary members of the International Pediatric Stroke Organization are coordinating global efforts to tackle these challenges and improve the outcomes in children with cerebrovascular disease.
Collapse
Affiliation(s)
- Peter B Sporns
- Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heather J Fullerton
- Departments of Neurology and Pediatrics, Benioff Children's Hospital, University of California at San Francisco, San Francisco, CA, USA
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Helen Kim
- Departments of Anesthesia and Perioperative Care, and Epidemiology and Biostatistics, Center for Cerebrovascular Research, University of California at San Francisco, San Francisco, CA, USA
| | - Warren D Lo
- Departments of Pediatrics and Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Mark T Mackay
- Department of Neurology, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Moritz Wildgruber
- Department of Radiology, University Hospital Munich, LMU Munich, Munich, Germany.
| |
Collapse
|
12
|
Lee S, Jiang B, Wintermark M, Mlynash M, Christensen S, Sträter R, Broocks G, Grams A, Dorn F, Nikoubashman O, Kaiser D, Morotti A, Jensen-Kondering U, Trenkler J, Möhlenbruch M, Fiehler J, Wildgruber M, Kemmling A, Psychogios M, Sporns PB. Cerebrovascular Collateral Integrity in Pediatric Large Vessel Occlusion: Analysis of the Save ChildS Study. Neurology 2022; 98:e352-e363. [PMID: 34795051 DOI: 10.1212/wnl.0000000000013081] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/22/2021] [Accepted: 11/04/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Robust cerebrovascular collaterals in adult patients with large vessel occlusion stroke have been associated with longer treatment windows, better recanalization rates, and improved outcomes, but the role of collaterals in pediatric stroke is not known. The primary aim was to determine whether favorable collaterals correlated with better radiographic and clinical outcomes in children with ischemic stroke who underwent thrombectomy. METHODS This study analyzed a subset of children enrolled in SaveChildS, a retrospective, multicenter, observational cohort study of 73 pediatric patients with stroke who underwent thrombectomy between 2000 and 2018 at 27 US and European centers. Included patients had baseline angiographic imaging and follow-up modified Rankin Scale scores available for review. Posterior circulation occlusions were excluded. Cerebrovascular collaterals were graded on acute neuroimaging by 2 blinded neuroradiologists according to the Tan collateral score, in which favorable collaterals are defined as >50% filling and unfavorable collaterals as <50% filling distal to the occluded vessel. Collateral status was correlated with clinical and neuroimaging characteristics and outcomes. Between-group comparisons were performed with the Wilcoxon rank-sum test for continuous variables or Fisher exact test for binary variables. RESULTS Thirty-three children (mean age 10.9 [SD ±4.9]) years were included; 14 (42.4%) had favorable collaterals. Median final stroke volume as a percent of total brain volume (TBV) was significantly lower in patients with favorable collaterals (1.35% [interquartile range (IQR) 1.14%-3.76%] vs 7.86% [IQR 1.54%-11.07%], p = 0.049). Collateral status did not correlate with clinical outcome, infarct growth, or final Alberta Stroke Program Early CT Score (ASPECTS) in our cohort. Patients with favorable collaterals had higher baseline ASPECTS (7 [IQR 6-8] vs 5.5 [4-6], p = 0.006), smaller baseline ischemic volume (1.57% TBV [IQR 1.09%-2.29%] vs 3.42% TBV [IQR 1.26%-5.33%], p = 0.035), and slower early infarct growth rate (2.4 mL/h [IQR 1.5-5.1 mL/h] vs 10.4 mL/h [IQR 3.0-30.7 mL/h], p = 0.028). DISCUSSION Favorable collaterals were associated with smaller final stroke burden and slower early infarct growth rate but not with better clinical outcome in our study. Prospective studies are needed to determine the impact of collaterals in childhood stroke. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in children with ischemic stroke undergoing thrombectomy, favorable collaterals were associated with improved radiographic outcomes but not with better clinical outcomes.
Collapse
Affiliation(s)
- Sarah Lee
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland.
| | - Bin Jiang
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Max Wintermark
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Michael Mlynash
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Soren Christensen
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Ronald Sträter
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Gabriel Broocks
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Astrid Grams
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Franziska Dorn
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Omid Nikoubashman
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Daniel Kaiser
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Andrea Morotti
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Ulf Jensen-Kondering
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Johannes Trenkler
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Markus Möhlenbruch
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Jens Fiehler
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Moritz Wildgruber
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - André Kemmling
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Marios Psychogios
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Peter B Sporns
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| |
Collapse
|
13
|
Beslow LA, Vossough A, Ichord RN, Slavova N, Yau MLY, Gajera J, Stojanovski B, Adil MM, Breimann J, Kimmel A, Mackay MT. Association of Pediatric ASPECTS and NIH Stroke Scale, Hemorrhagic Transformation, and 12-Month Outcome in Children With Acute Ischemic Stroke. Neurology 2021; 97:e1202-e1209. [PMID: 34389646 DOI: 10.1212/wnl.0000000000012558] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/25/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We aimed to determine whether a modified pediatric Alberta Stroke Program Early CT Score (modASPECTS) is associated with clinical stroke severity, hemorrhagic transformation, and 12-month functional outcomes in children with acute arterial ischemic stroke (AIS). METHODS Children (age 29 days-<18 years) with acute AIS enrolled in 2 institutional prospective stroke registries at the Children's Hospital of Philadelphia and Royal Children's Hospital Melbourne, Australia were retrospectively analyzed to determine whether modASPECTS, in which higher scores are worse, correlated with acute pediatric NIH Stroke Scale (PedNIHSS) scores (children ≥2 years of age), was associated with hemorrhagic transformation on acute MRI, and correlated with 12-month functional outcome on the Pediatric Stroke Outcome Measure. RESULTS One hundred thirty-one children were included; 91 were ≥2 years of age. Median time from stroke to MRI was 1 day (interquartile range [IQR] 0-1 day). Median modASPECTS was 4 (IQR 3-7). ModASPECTS correlated with PedNIHSS score (ρ = 0.40, p = 0.0001). ModASPECTS was associated with hemorrhagic transformation (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.02-1.25, p = 0.018). Among children with follow-up (n = 128, median 12.2 months, IQR 9.5-15.4 months), worse outcomes were associated with higher modASPECTS (common OR 1.14, 95% CI 1.04-1.24, p = 0.005). The association between modASPECTS and outcome persisted when we adjusted for age at stroke ictus and the presence of tumor or meningitis as stroke risk factors (common OR 1.14, 95% CI 1.03-1.25, p = 0.008). DISCUSSION ModASPECTS correlates with PedNIHSS scores, hemorrhagic transformation, and 12-month functional outcome in children with acute AIS. Future pediatric studies should evaluate its usefulness in predicting symptomatic intracranial hemorrhage and outcome after acute revascularization therapies. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that the modASPECTS on MRI is associated with stroke severity (as measured by the baseline PedNIHSS score), hemorrhagic transformation, and 12-month outcome in children with acute supratentorial ischemic stroke.
Collapse
Affiliation(s)
- Lauren A Beslow
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia.
| | - Arastoo Vossough
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
| | - Rebecca N Ichord
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
| | - Nedelina Slavova
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
| | - Maggie L Y Yau
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
| | - Jay Gajera
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
| | - Belinda Stojanovski
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
| | - Malik M Adil
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
| | - Jake Breimann
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
| | - Alexandra Kimmel
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
| | - Mark T Mackay
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
| |
Collapse
|
14
|
Visser MJ, Yang JYM, Calamante F, Kean M, Adamson CL, Sharma G, Anderson V, Campbell BCV, Mackay MT. Automated Perfusion-Diffusion Magnetic Resonance Imaging in Childhood Arterial Ischemic Stroke. Stroke 2021; 52:3296-3304. [PMID: 34404238 DOI: 10.1161/strokeaha.120.032822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Melissa J Visser
- Brain and Mind (M.J.V., V.A.), Murdoch Children's Research Institute, Parkville, Australia.,Melbourne School of Psychological Sciences (M.J.V., V.A.), University of Melbourne, Parkville, Australia
| | - Joseph Yuan-Mou Yang
- Neuroscience Research (J.Y.-M.Y., M.K., M.T.M.), Murdoch Children's Research Institute, Parkville, Australia.,Developmental Imaging (J.Y.-M.Y., C.L.A.), Murdoch Children's Research Institute, Parkville, Australia.,Department of Pediatrics (J.Y.-M.Y., V.A., M.T.M.), University of Melbourne, Parkville, Australia.,Neuroscience Advanced Clinical Imaging Service (NACIS), Department of Neurosurgery (J.Y.-M.Y.), Royal Children's Hospital, Parkville, Australia
| | - Fernando Calamante
- The University of Sydney, Sydney Imaging and School of Biomedical Engineering, Australia (F.C.)
| | - Michael Kean
- Neuroscience Research (J.Y.-M.Y., M.K., M.T.M.), Murdoch Children's Research Institute, Parkville, Australia
| | - Christopher L Adamson
- Developmental Imaging (J.Y.-M.Y., C.L.A.), Murdoch Children's Research Institute, Parkville, Australia.,Department of Electrical and Electronic Engineering (C.L.A.), University of Melbourne, Parkville, Australia
| | - Gagan Sharma
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital (G.S., B.C.V.C.), University of Melbourne, Parkville, Australia
| | - Vicki Anderson
- Brain and Mind (M.J.V., V.A.), Murdoch Children's Research Institute, Parkville, Australia.,Melbourne School of Psychological Sciences (M.J.V., V.A.), University of Melbourne, Parkville, Australia.,Department of Pediatrics (J.Y.-M.Y., V.A., M.T.M.), University of Melbourne, Parkville, Australia
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital (G.S., B.C.V.C.), University of Melbourne, Parkville, Australia.,Florey Institute of Neurosciences and Mental Health, Parkville, Australia (B.C.V.C.)
| | - Mark T Mackay
- Neuroscience Research (J.Y.-M.Y., M.K., M.T.M.), Murdoch Children's Research Institute, Parkville, Australia.,Department of Pediatrics (J.Y.-M.Y., V.A., M.T.M.), University of Melbourne, Parkville, Australia.,Department of Neurology (M.T.M.), Royal Children's Hospital, Parkville, Australia
| |
Collapse
|
15
|
Sporns PB, Fullerton HJ, Lee S, Kirton A, Wildgruber M. Current treatment for childhood arterial ischaemic stroke. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:825-836. [PMID: 34331864 DOI: 10.1016/s2352-4642(21)00167-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 12/23/2022]
Abstract
Paediatric arterial ischaemic stroke is an important cause of neurological morbidity in children, with consequences including motor disorders, intellectual impairment, and epilepsy. The causes of paediatric arterial ischaemic stroke are unique compared with those associated with stroke in adulthood. The past decade has seen substantial advances in paediatric stroke research and clinical care, but many unanswered questions and controversies remain. Shortage of prospective evidence for the use of recanalisation therapies in patients with paediatric stroke has resulted in little standardisation of disease management. Substantial time delays in diagnosis and treatment continue to challenge best possible care. In this Review, we highlight on some of the most pressing and productive aspects of research in the treatment of arterial ischaemic stroke in children, including epidemiology and cause, rehabilitation, secondary stroke prevention, and treatment updates focusing on advances in hyperacute therapies such as intravenous thrombolysis, mechanical thrombectomy, and critical care. Finally, we provide a future perspective for improving outcomes and quality of life for affected children and their families.
Collapse
Affiliation(s)
- Peter B Sporns
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heather J Fullerton
- Departments of Neurology and Pediatrics, Weill Institute of Neurosciences, University of California at San Francisco, San Francisco, CA, USA
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology, Stanford University, Palo Alto, CA, USA
| | - Adam Kirton
- Department of Pediatrics and Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Moritz Wildgruber
- Department of Radiology, University Hospital Munich, LMU Munich, Munich, Germany.
| |
Collapse
|
16
|
Sood A, Suthar R, Sahu JK, K Baranwal A, Saini AG, Saini L, Vyas S, Khandelwal N, Sankhyan N. Etiologic Profile of Childhood Stroke from North India: Is It Different from Developed World? J Child Neurol 2021; 36:655-663. [PMID: 33622066 DOI: 10.1177/0883073821991291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the etiology of childhood arterial-ischemic stroke from a developing country and assess short-term neurologic outcome. METHODS Prospective observational study. Consecutive children between the age of >28 days to <12 years, admitted with the diagnosis of arterial-ischemic stroke were enrolled during the study period from January 2017 to December 2018. Short-term neurologic outcome was assessed with Pediatric Cerebral Performance Category (PCPC) scale and Pediatric Stroke Outcome Measure (PSOM). RESULTS We enrolled 76 children with arterial-ischemic stroke, with a median age of 24 months (interquartile range 12-69), and 43 (57%) were boys. The most common risk factor for childhood arterial-ischemic stroke was arteriopathy in 59 (77%), followed by cardiovascular disorder in 12 (16%) children. Among 59 children with arteriopathy, 32 (42%) had infection-associated arteriopathies, 10 (13%) had mineralizing angiopathy, 10 (13%) had moyamoya disease. Pediatric stroke risk factors were classified according to Pediatric Stroke Classification and CASCADE primary classification. Short-term neurologic outcome was assessed at 3 months in 62 (82%) survivors. Among stroke survivors, 33 (61%) had sensory-motor deficits, and 24 (39%) had severe neurologic disability (PCPC ≥ 4). The presence of fever, encephalopathy, low Glasgow coma score at presentation, seizures, and infection-associated arteriopathy predicted severe neurologic disability at follow-up. CONCLUSION The risk factors for pediatric arterial-ischemic stroke are different from developed countries in our cohort. Infection-associated arteriopathies, mineralizing angiopathy, and moyamoya disease are the most common risk factors in our cohort. Two-thirds of pediatric stroke survivors have neurologic disability at short-term follow-up.
Collapse
Affiliation(s)
- Abhinandan Sood
- Pediatric Neurology Unit, Department of Pediatrics, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Suthar
- Pediatric Neurology Unit, Department of Pediatrics, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitendra K Sahu
- Pediatric Neurology Unit, Department of Pediatrics, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun K Baranwal
- Pediatric Emergency and Intensive Care Unit, Department of Pediatrics, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arushi G Saini
- Pediatric Neurology Unit, Department of Pediatrics, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Lokesh Saini
- Pediatric Neurology Unit, Department of Pediatrics, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Vyas
- Department of Radiodiagnosis, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
17
|
Pizzatto R, Resende LL, Lobo CFT, Neves YCS, Paz JAD, Alves CAPF, Leite CDC, Lucato LT. Arteriopathy in pediatric stroke: an underestimated clinical entity. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:321-333. [PMID: 34133513 DOI: 10.1590/0004-282x-anp-2020-0105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pediatric arterial ischemic stroke (AIS), which was thought to be a rare disorder, is being increasingly recognized as an important cause of neurological morbidity, thanks to new advances in neuroimaging. OBJECTIVE The aim of this study was to review the main etiologies of stroke due to arteriopathy in children. METHODS Using a series of cases from our institution, we addressed its epidemiological aspects, physiopathology, imaging findings from CT, MR angiography, MR conventional sequences and MR DWI, and nuclear medicine findings. RESULTS Through discussion of the most recent classification for childhood AIS (Childhood AIS Standardized Classification and Diagnostic Evaluation, CASCADE), we propose a modified classification based on the anatomical site of disease, which includes vasculitis, varicella, arterial dissection, moyamoya, fibromuscular dysplasia, Takayasu's arteritis and genetic causes (such as ACTA-2 mutation, PHACE syndrome and ADA-2 deficiency). We have detailed each of these separately. Conclusions: Prompt recognition of AIS and thorough investigation for potential risk factors are crucial for a better outcome. In this scenario, neurovascular imaging plays an important role in diagnosing AIS and identifying children at high risk of recurrent stroke.
Collapse
Affiliation(s)
- Ronaldo Pizzatto
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil
| | - Lucas Lopes Resende
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil
| | - Carlos Felipe Teixeira Lobo
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil
| | - Yuri Costa Sarno Neves
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil
| | - José Albino da Paz
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Pediatria, São Paulo SP, Brazil
| | | | - Claudia da Costa Leite
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil
| | - Leandro Tavares Lucato
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil
| |
Collapse
|
18
|
Rafay MF, Shapiro KA, Surmava AM, deVeber GA, Kirton A, Fullerton HJ, Amlie-Lefond C, Weschke B, Dlamini N, Carpenter JL, Mackay MT, Rivkin M, Linds A, Bernard TJ. Spectrum of cerebral arteriopathies in children with arterial ischemic stroke. Neurology 2020; 94:e2479-e2490. [PMID: 32457211 DOI: 10.1212/wnl.0000000000009557] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/25/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine that children with arterial ischemic stroke (AIS) due to an identifiable arteriopathy are distinct from those without arteriopathy and that each arteriopathy subtype has unique and recognizable clinical features. METHODS We report a large, observational, multicenter cohort of children with AIS, age 1 month to 18 years, enrolled in the International Pediatric Stroke Study from 2003 to 2014. Clinical and demographic differences were compared by use of the Fisher exact test, with linear step-up permutation min-p adjustment for multiple comparisons. Exploratory analyses were conducted to evaluate differences between cases of AIS with and without arteriopathy and between arteriopathy subtypes. RESULTS Of 2,127 children with AIS, 725 (34%) had arteriopathy (median age 7.45 years). Arteriopathy subtypes included dissection (27%), moyamoya (24.5%), focal cerebral arteriopathy-inflammatory subtype (FCA-i; 15%), diffuse cerebral vasculitis (15%), and nonspecific arteriopathy (18.5%). Children with arteriopathic AIS were more likely to present between 6 and 9 years of age (odds ratio [OR] 1.93, p = 0.029) with headache (OR 1.55, p = 0.023), multiple infarctions (OR 2.05, p < 0.001), sickle cell anemia (OR 2.9, p = 0.007), and head/neck trauma (OR 1.93, p = 0.018). Antithrombotic use and stroke recurrence were higher in children with arteriopathy. Among arteriopathy subtypes, dissection was associated with male sex, older age, headache, and anticoagulant use; FCA-i was associated with hemiparesis and single infarcts; moyamoya was associated with seizures and recurrent strokes; and vasculitis was associated with bilateral infarctions. CONCLUSION Specific clinical profiles are associated with cerebral arteriopathies in children with AIS. These observations may be helpful indicators in guiding early diagnosis and defining subgroups who may benefit most from future therapeutic trials.
Collapse
Affiliation(s)
- Mubeen F Rafay
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver.
| | - Kevin A Shapiro
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Ann-Marie Surmava
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Gabrielle A deVeber
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Adam Kirton
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Heather J Fullerton
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Catherine Amlie-Lefond
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Bernhard Weschke
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Nomazulu Dlamini
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Jessica L Carpenter
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Mark T Mackay
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Michael Rivkin
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Alexandra Linds
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Timothy J Bernard
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | | |
Collapse
|
19
|
|
20
|
Smitka M, Bruck N, Engellandt K, Hahn G, Knoefler R, von der Hagen M. Clinical Perspective on Primary Angiitis of the Central Nervous System in Childhood (cPACNS). Front Pediatr 2020; 8:281. [PMID: 32719754 PMCID: PMC7349935 DOI: 10.3389/fped.2020.00281] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 05/04/2020] [Indexed: 12/21/2022] Open
Abstract
Non-arteriosclerotic arteriopathies have emerged as important underlying pathomechanism in pediatric arterial ischemic stroke (AIS). The pathogenesis and classification of cerebral arteriopathies in childhood are heterogeneous. Different classifications base on (i) the anatomic site; (ii) the distribution and size of the affected vessel; (iii) the time course, for example, transient vs. progressive, monophasic vs. recurrent; (iv) the putative pathogenesis; (v) the magnetic resonance imaging morphology of the vasculopathies. Inflammation affecting the cerebral vessels is increasingly recognized as common cause of pediatric AIS. Primary cerebral vasculitis or primary angiitis of the central nervous system (CNS) in childhood (cPACNS) is an important differential diagnosis in pediatric AIS. Primary angiitis of the CNS is a rare disorder, and the pathogenesis is poorly understood so far. The current classification of cPACNS is based on the affected cerebral vessel size, the disease course, and angiographic pattern. Two large subtypes are currently recognized comprising large- and medium-sized vessel CNS vasculitis referred to as angiography-positive cPACNS and angiography-negative small vessel cPACNS. As the clinical manifestations of cPACNS are rather diverse, precise diagnosis can be challenging for the treating pediatrician because of the lack of vital laboratory tests or imaging features. Initial misdiagnosis is common because of overlapping phenotypes and pediatric AIS mimics. As untreated cPACNS is associated with a high morbidity and mortality, timely diagnosis, and induction of immunomodulatory and symptomatic therapy are essential. Survival and neurological outcome depend on early diagnosis and prompt therapy. Primary angiitis of the central nervous system in childhood differs in several aspects from primary cerebral angiitis in adults. The aim of this article is to give a brief comprehensive summary on pediatric primary cerebral vasculitis focusing on the clinical perspective regarding the classification, the putative pathogenesis, the disease course, the diagnostic tools, and emerging treatment options. A modified terminology for clinical practice is discussed.
Collapse
Affiliation(s)
- Martin Smitka
- Abteilung Neuropädiatrie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Normi Bruck
- Klinik für Kinder und Jugendmedizin, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kay Engellandt
- Department of Neuroradiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gabriele Hahn
- Bereich Kinderradiologie, Medizinische Fakultät Carl Gustav Carus, Institut und Poliklinik für Radiologische Diagnostik, Technische Universität Dresden, Dresden, Germany
| | - Ralf Knoefler
- Klinik für Kinder und Jugendmedizin, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Maja von der Hagen
- Abteilung Neuropädiatrie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
21
|
Nash M, Rafay MF. Craniocervical Arterial Dissection in Children: Pathophysiology and Management. Pediatr Neurol 2019; 95:9-18. [PMID: 30955992 DOI: 10.1016/j.pediatrneurol.2019.01.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/24/2019] [Accepted: 01/26/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Craniocervical arterial dissection is a commonly reported arteriopathy associated with stroke in children. It is characterized by a high stroke recurrence rate and variable outcomes. Here we review the pathophysiology, clinical presentation, and diagnostic neuroimaging approaches that are helpful in accurate diagnosis and follow-up of children with arterial dissection. METHODS MEDLINE searches (2000 to 2018) for articles that contained patients aged less than 18 years with craniocervical arterial dissection was performed, with the goal of analyzing their presenting features, pathophysiological mechanisms, and imaging characteristics and interventions. RESULTS Sixteen articles met the study criteria and reported 182 cases of craniocervical arterial dissection, 68% male, average age 8.6 years. Dissection was associated with head and neck trauma in 56% of the cases and frequently involved the posterior (61%) and extracranial locations (64%); the vertebral artery was the most commonly involved artery (60%). The most common clinical presentation was hemiparesis (80/160, 50%), followed by headache (64/164, 39%). Magnetic resonance imaging was the preferred neuroimaging method, followed by cerebral catheter angiography as a gold standard definitive neurovascular imaging modality when the initial vascular imaging revealed nondiagnostic findings. CONCLUSIONS The diagnosis of arterial dissection requires a high index of suspicion and consideration for detailed neurovascular imaging, including both the cranial and cervical regions. Neurovascular imaging challenges, especially visualization of arterial abnormalities, highlight the importance of appropriate and timely use of specific neurovascular imaging techniques. Magnetic resonance imaging appears to be the preferred neurovascular imaging modality in children with arterial dissection and may obviate the need for invasive cerebral catheter angiography.
Collapse
Affiliation(s)
- Monica Nash
- Department of Nursing, Red River College, Winnipeg, Manitoba, Canada
| | - Mubeen F Rafay
- Section of Pediatric Neurology, Department of Pediatrics and Child Health, University of Manitoba, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
| |
Collapse
|
22
|
Abstract
The vasculitides are diseases characterized by inflammation of blood vessels and inflammatory leukocytes in vessel walls. There is an increased propensity for ischemic stroke, resulting from compromise of vessel lumina with distal tissue ischemia; and hemorrhagic or nonhemorrhagic stroke, and aneurysmal formation and bleeding, due to loss of vessel integrity.
Collapse
Affiliation(s)
- David S Younger
- Department of Neurology, Division of Neuro-Epidemiology, New York University School of Medicine, New York, NY, USA; School of Public Health, City University of New York, New York, NY, USA.
| |
Collapse
|
23
|
Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2019; 50:e51-e96. [DOI: 10.1161/str.0000000000000183] [Citation(s) in RCA: 240] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
24
|
Böhmer M, Niederstadt T, Heindel W, Wildgruber M, Sträter R, Hanning U, Kemmling A, Sporns PB. Impact of Childhood Arterial Ischemic Stroke Standardized Classification and Diagnostic Evaluation Classification on Further Course of Arteriopathy and Recurrence of Childhood Stroke. Stroke 2019; 50:83-87. [PMID: 30580701 DOI: 10.1161/strokeaha.118.023060] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Arterial ischemic stroke (AIS) in childhood is a severe disease with potentially lifelong restrictions. Apart from cardiac or prothrombotic embolism, arteriopathy has been identified as a major cause and significant target of secondary stroke prevention. The Childhood Arterial Ischemic Stroke Standardized Classification and Diagnostic Evaluation (CASCADE) criteria facilitate a structured tool for categorizing and reporting childhood strokes according to the underlying cause. Our study aims to identify the prognostic value of CASCADE classification on admission for further course of arteriopathy and risk of stroke recurrence. Moreover, we give recommendations for follow-up imaging based on different CASCADE subgroups. Methods- Between 2004 and 2017, we identified 86 children with an acute arterial ischemic stroke classified in the 7-basic and 19-expanded subgroups of the acute CASCADE criteria. All included children were diagnosed and followed-up by magnetic resonance imaging. All arteriopathic strokes (basic subgroups 1-4 of acute CASCADE criteria) were further categorized into the chronic CASCADE criteria, including progressive, stable, reversible, and indeterminate course. Outcomes were defined as stroke recurrence and course of arteriopathy according to chronic CASCADE criteria. Associations between acute CASCADE criteria classification and stroke recurrence were assessed by Fisher exact test and between acute CASCADE criteria and chronic CASCADE criteria by Fisher exact test and Mann-Whitney U test. Results- A total of 86 children were included; of these, 57 presented with arteriopathic stroke (CASCADE 1-4) and 29 as nonarteriopathic. Unilateral cerebral arteriopathy (CASCADE 2; P=0.036) and bilateral cerebral arteriopathy (CASCADE 3; P=0.016) significantly correlated with stroke recurrence, and progressive arteriopathy significantly correlated with unilateral focal cerebral arteriopathy (P<0.001). Time points of progress of arteriopathy differed; whereas patients with unilateral focal cerebral arteriopathy presented with early median progress after 11 days, patients with bilateral cerebral arteriopathy had a significantly later median progress after 124 days (P=0.005). Conclusions- Initial CASCADE classification is associated with risk of recurrent strokes and progress of arteriopathy. Moreover, time points of arteriopathic progress vary according to the underlying cause.
Collapse
Affiliation(s)
- Maik Böhmer
- From the Institute of Clinical Radiology (M.B., T.N., W.H., M.W., A.K., P.B.S.), Westfaelische Wilhelms-University of Muenster and Albert-Schweitzer-Campus 1, Germany
| | - Thomas Niederstadt
- From the Institute of Clinical Radiology (M.B., T.N., W.H., M.W., A.K., P.B.S.), Westfaelische Wilhelms-University of Muenster and Albert-Schweitzer-Campus 1, Germany
| | - Walter Heindel
- From the Institute of Clinical Radiology (M.B., T.N., W.H., M.W., A.K., P.B.S.), Westfaelische Wilhelms-University of Muenster and Albert-Schweitzer-Campus 1, Germany
| | - Moritz Wildgruber
- From the Institute of Clinical Radiology (M.B., T.N., W.H., M.W., A.K., P.B.S.), Westfaelische Wilhelms-University of Muenster and Albert-Schweitzer-Campus 1, Germany
| | - Ronald Sträter
- Department of Pediatrics, University Hospital of Muenster (R.S.), Westfaelische Wilhelms-University of Muenster and Albert-Schweitzer-Campus 1, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (U.H.)
| | - André Kemmling
- From the Institute of Clinical Radiology (M.B., T.N., W.H., M.W., A.K., P.B.S.), Westfaelische Wilhelms-University of Muenster and Albert-Schweitzer-Campus 1, Germany
| | - Peter B Sporns
- From the Institute of Clinical Radiology (M.B., T.N., W.H., M.W., A.K., P.B.S.), Westfaelische Wilhelms-University of Muenster and Albert-Schweitzer-Campus 1, Germany
| |
Collapse
|
25
|
Tho-Calvi SC, Thompson D, Saunders D, Agrawal S, Basu A, Chitre M, Chow G, Gibbon F, Hart A, Tallur KK, Kirkham F, Kneen R, McCullagh H, Mewasingh L, Vassallo G, Vijayakumar K, Wraige E, Yeo TH, Ganesan V. Clinical features, course, and outcomes of a UK cohort of pediatric moyamoya. Neurology 2018; 90:e763-e770. [DOI: 10.1212/wnl.0000000000005026] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/17/2017] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo describe characteristics and course of a large UK cohort of children with moyamoya from multiple centers and examine prognostic predictors.MethodsRetrospective review of case notes/radiology, with use of logistic regression to explore predictors of outcome.ResultsEighty-eight children (median presentation age 5.1 years) were included. Thirty-six presented with arterial ischemic stroke (AIS) and 29 with TIA. Eighty had bilateral and 8 unilateral carotid circulation disease; 29 patients had posterior circulation involvement. Acute infarction was present in 36/176 hemispheres and chronic infarction in 86/176 hemispheres at the index presentation. Sixty-two of 82 with symptomatic presentation had at least one clinical recurrence. Fifty-five patients were treated surgically, with 37 experiencing fewer recurrences after surgery. Outcome was categorized as good using the Recovery and Recurrence Questionnaire in 39/85 patients. On multivariable analysis, presentation with TIA (odds ratio [OR] 0.09, 95% confidence interval [CI] 0.02–0.35), headache (OR 0.10, 95% CI 0.02–0.58), or no symptoms (OR 0.08, 95% CI 0.01–0.68) was less likely to predict poor outcome than AIS presentation. Posterior circulation involvement predicted poor outcome (OR 4.22, 95% CI 1.23–15.53). Surgical revascularization was not a significant predictor of outcome.ConclusionsMoyamoya is associated with multiple recurrences, progressive arteriopathy, and poor outcome in half of patients, especially with AIS presentation and posterior circulation involvement. Recurrent AIS is rare after surgery. Surgery was not a determinant of overall outcome, likely reflecting surgical case selection and presentation clinical status.
Collapse
|
26
|
Pediatric arterial ischemic stroke: Epidemiology, risk factors, and management. Blood Cells Mol Dis 2017; 67:23-33. [PMID: 28336156 DOI: 10.1016/j.bcmd.2017.03.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 12/17/2022]
Abstract
Pediatric arterial ischemic stroke (AIS) is an uncommon but important cause of neurologic morbidity in neonates and children, with consequences including hemiparesis, intellectual disabilities, and epilepsy. The causes of pediatric AIS are unique to those typically associated with stroke in adults. Familiarity with the risk factors for AIS in children will help with efficient diagnosis, which is unfortunately frequently delayed. Here we review the epidemiology and risk factors for AIS in neonates and children. We also outline consensus-based practices in the evaluation and management of pediatric AIS. Finally we discuss the outcomes observed in this population. While much has been learned in recent decades, many uncertainties sill persist in regard to pediatric AIS. The ongoing development of specialized centers and investigators dedicated to pediatric stroke will continue to answer such questions and improve our ability to effectively care for these patients.
Collapse
|
27
|
Chabrier S, Sébire G, Fluss J. Transient Cerebral Arteriopathy, Postvaricella Arteriopathy, and Focal Cerebral Arteriopathy or the Unique Susceptibility of the M1 Segment in Children With Stroke. Stroke 2016; 47:2439-41. [PMID: 27633022 DOI: 10.1161/strokeaha.116.014606] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Stéphane Chabrier
- From the CHU Saint-Étienne, French Center for Pediatric Stroke, Hôpital Bellevue, Saint-Étienne F-42055, France (S.C.); Child Neurology Division, Montreal Children's Hospital, McGill University, Canada (G.S.); and Pediatric Neurology Unit, Geneva University Hospitals, Children's Hospital, Genève, Switzerland (J.F.).
| | - Guillaume Sébire
- From the CHU Saint-Étienne, French Center for Pediatric Stroke, Hôpital Bellevue, Saint-Étienne F-42055, France (S.C.); Child Neurology Division, Montreal Children's Hospital, McGill University, Canada (G.S.); and Pediatric Neurology Unit, Geneva University Hospitals, Children's Hospital, Genève, Switzerland (J.F.)
| | - Joel Fluss
- From the CHU Saint-Étienne, French Center for Pediatric Stroke, Hôpital Bellevue, Saint-Étienne F-42055, France (S.C.); Child Neurology Division, Montreal Children's Hospital, McGill University, Canada (G.S.); and Pediatric Neurology Unit, Geneva University Hospitals, Children's Hospital, Genève, Switzerland (J.F.)
| |
Collapse
|