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Arterial Ischemic Stroke Secondary to Cardiac Disease in Neonates and Children.
Chung, Melissa G; Guilliams, Kristin P; Wilson, Jenny L; Beslow, Lauren A; Dowling, Michael M; Friedman, Neil R; Hassanein, Sahar M A; Ichord, Rebecca; Jordan, Lori C; Mackay, Mark T; Rafay, Mubeen F; Rivkin, Michael; Torres, Marcela; Zafeiriou, Dimitrios; deVeber, Gabrielle; Fox, Christine K.
Afiliación
  • Chung MG; Divisions of Critical Care Medicine and Neurology, Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio. Electronic address: Melissa.chung@nationwidechildrens.org.
  • Guilliams KP; Departments of Neurology and Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
  • Wilson JL; Division of Neurology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon.
  • Beslow LA; Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perlman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
  • Dowling MM; Departments of Pediatrics, Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas and Children's Health Dallas, Dallas, Texas.
  • Friedman NR; Center for Pediatric Neurosciences, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
  • Hassanein SMA; Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
  • Ichord R; Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perlman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
  • Jordan LC; Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
  • Mackay MT; Department of Neurology, Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia.
  • Rafay MF; Section of Pediatric Neurology, Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
  • Rivkin M; Departments of Neurology, Psychiatry, and Radiology, and the Stroke and Cerebrovascular Center, Boston Children's Hospital, Boston, Massachusetts.
  • Torres M; Pediatric Hematology and Oncology, Cook Children's Medical Center, Fort Worth, Texas.
  • Zafeiriou D; 1(st) Department of Pediatrics, Aristotle University, "Hippokratio" General Hospital, Thessaloniki, Greece.
  • deVeber G; Department of Neurology, The Hospital for Sick Children, Toronto, Canada.
  • Fox CK; Departments of Neurology and Pediatrics, University of California San Francisco, San Francisco, California.
Pediatr Neurol ; 100: 35-41, 2019 11.
Article en En | MEDLINE | ID: mdl-31371125
OBJECTIVE: We describe the risk factors for peri-procedural and spontaneous arterial ischemic stroke (AIS) in children with cardiac disease. METHODS: We identified children with cardiac causes of AIS enrolled in the International Pediatric Stroke Study registry from January 2003 to July 2014. Isolated patent foramen ovale was excluded. Peri-procedural AIS (those occurring during or within 72 hours of cardiac surgery, cardiac catheterization, or mechanical circulatory support) and spontaneous AIS that occurred outside of these time periods were compared. RESULTS: We identified 672 patients with congenital or acquired cardiac disease as the primary risk factor for AIS. Among these, 177 patients (26%) had peri-procedural AIS and 495 patients (74%) had spontaneous AIS. Among non-neonates, spontaneous AIS occurred at older ages (median 4.2 years, interquartile range 0.97 to 12.4) compared with peri-procedural AIS (median 2.4 years, interquartile range 0.35 to 6.1, P < 0.001). About a third of patients in both groups had a systemic illness at the time of AIS. Patients who had spontaneous AIS were more likely to have a preceding thrombotic event (16 % versus 9 %, P = 0.02) and to have a moderate or severe neurological deficit at discharge (67% versus 33%, P = 0.01) compared to those with peri-procedural AIS. CONCLUSIONS: Children with cardiac disease are at risk for AIS at the time of cardiac procedures but also outside of the immediate 72 hours after procedures. Many have acute systemic illness or thrombotic event preceding AIS, suggesting that inflammatory or prothrombotic conditions could act as a stroke trigger in this susceptible population.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Tromboembolia / Isquemia Encefálica / Sistema de Registros / Accidente Cerebrovascular / Enfermedades Arteriales Intracraneales / Cardiopatías / Procedimientos Quirúrgicos Cardíacos Tipo de estudio: Prognostic_studies / Risk_factors_studies Límite: Child / Child, preschool / Female / Humans / Infant / Male / Newborn Idioma: En Revista: Pediatr Neurol Asunto de la revista: NEUROLOGIA / PEDIATRIA Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Tromboembolia / Isquemia Encefálica / Sistema de Registros / Accidente Cerebrovascular / Enfermedades Arteriales Intracraneales / Cardiopatías / Procedimientos Quirúrgicos Cardíacos Tipo de estudio: Prognostic_studies / Risk_factors_studies Límite: Child / Child, preschool / Female / Humans / Infant / Male / Newborn Idioma: En Revista: Pediatr Neurol Asunto de la revista: NEUROLOGIA / PEDIATRIA Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos