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Presumed pre‐ or perinatal arterial ischemic stroke: Risk factors and outcomes
Author(s) -
Golomb Meredith R.,
MacGregor Daune L.,
Domi Trish,
Armstrong Derek C.,
McCrindle Brian W.,
Mayank Supriya,
DeVeber Gabrielle A.
Publication year - 2001
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.1078
Subject(s) - medicine , activated protein c resistance , thrombophilia , lupus anticoagulant , factor v leiden , methylenetetrahydrofolate reductase , stroke (engine) , hemiparesis , pediatrics , protein c deficiency , thrombosis , cardiology , venous thrombosis , surgery , angiography , mechanical engineering , biochemistry , chemistry , genotype , engineering , gene
A subgroup of children with arterial ischemic stroke in the pre‐ or perinatal period present with delayed diagnosis. We identified 22 children who met the following criteria: (1) normal neonatal neurological history, (2) hemiparesis and/or seizures first recognized after 2 months of age, and (3) computed tomography or magnetic resonance imaging showing remote cerebral infarct. Laboratory evaluations included protein C, protein S, antithrombin, activated protein C resistance screen (APCR), Factor V Leiden (FVL), prothrombin gene defect, methylene tetrahydrofolate reductase variant (MTHFR), anticardiolipin antibody (ACLA), and lupus anticoagulant. Not all children received all tests. Age at last visit ranged from 8 months to 16.5 years (median 4 years). Twelve were boys. Fourteen had left hemisphere infarcts. Median age at presentation was 6 months. Eighteen had gestational complications. Fourteen children had at least transient coagulation abnormalities (ACLA = 11, ACLA + APCR = 1, APCR = 2 with FVL + MTHFR = 1); 6 of these children had family histories suggestive of thrombosis. Cardiac echocardiogram was unremarkable in the 15 tested. Outcomes included persistent hemiparesis in 22; speech, behavior, or learning problems in 12; and persistent seizures in 5, with no evidence of further stroke in any patient. The persistence and importance of coagulation abnormalities in this group need further study.