Journal of Pediatric Neurology - Volume 8, issue 3

Article Type: Other

DOI: 10.3233/JPN-2010-0406

Citation: Journal of Pediatric Neurology, vol. 8, no. 3, pp. 243-244, 2010

Authors: Simma, Burkhard | Lütschg, Jürg

Article Type: Research Article

Abstract: Stroke may be an underestimated disease in children and adolescents. Several studies report an annual incidence as high as for brain tumors: 2–13 children for arterial ischemic, 1–5 for hemorrhagic stroke and 0.67/100,000 children for cerebral venous thrombosis. Recurrence of stroke ranges from 10–20% and depends on the underlying risk factors. Genetic predisposition underlying diseases and risk factors can often not be separated very precisely. The most prominent risk factors are vasculapathies and …congenital heart disease, sickle cell anemia, coagulopathies, metabolic disorders and infections. Disorders in lipometabolism and genetic predisposition are now known to play also a role in the pathogenesis of pediatric stroke. A distinct stroke etiology can be determined only in a minority of children. However, most of them (> 80%) have more than one risk factor. The purpose of this review is to describe the epidemiology, risk factors, and etiologies of pediatric stroke in order to give rationales for understanding clinical symptoms and treatment decisions. Show more

Keywords: Stroke, epidemiology, etiology, pediatric

DOI: 10.3233/JPN-2010-0402

Citation: Journal of Pediatric Neurology, vol. 8, no. 3, pp. 245-249, 2010

Authors: Shellhaas, Renée A. | Smith, Sabrina E.

Article Type: Research Article

Abstract: Stroke is more common in the newborn period than at any other time in childhood and carries the risk of significant long-term neurodevelopmental morbidity. Arterial ischemic stroke may present acutely in the neonatal period, or may come to attention later when the child develops a hemiparesis or symptomatic epilepsy syndrome. Case-control and hospital-based cohort studies have revealed many factors associated with arterial ischemic perinatal stroke (IPS), including congenital heart disease, placental pathology, and …thrombophilia. Since both motor and cognitive abnormalities may result, supportive care of the individual with arterial IPS requires a multidisciplinary approach and must extend beyond the acute illness phase. Herein we review the epidemiology, presentation, risk factors, suggested diagnostic approach, treatment, and outcomes of arterial IPS. Show more

Keywords: Ischemic perinatal stroke, neonatal stroke

DOI: 10.3233/JPN-2010-0405

Citation: Journal of Pediatric Neurology, vol. 8, no. 3, pp. 251-258, 2010

Authors: Friedman, Neil

Article Type: Research Article

Abstract: Congenital heart disease is among the most common birth defects encountered. Stroke may occur as a consequence of the underlying heart defect itself, or secondary to life-saving cardiothoracic surgical procedures. Advancements in surgical techniques and improved survival require a new assessment of the epidemiology, risk factors, prevention and treatment options of stroke in the pediatric population. In this review, we discuss the most common associations between cardiothoracic interventions and stroke and review …evaluation and treatment options. Show more

Keywords: Heart defect, stroke, cardiothoracic procedures

DOI: 10.3233/JPN-2010-0399

Citation: Journal of Pediatric Neurology, vol. 8, no. 3, pp. 259-265, 2010

Authors: Sivaswamy, Lalitha | Altinok, Deniz | Juhász, Csaba

Article Type: Research Article

Abstract: Multiple modalities for imaging of pediatric stroke are available, though not all have clinical application in acute stage. In this article, we review the relative advantages and disadvantages of imaging methods designed to visualize the brain parenchyma, arteries, veins as well as the penumbra in arterial and venous ischemic events of childhood and perinatal strokes. The applications of diffusion-weighted magnetic resonance imaging (MRI) in the setting of neonatal stroke have led to a better understanding of …the extent of damage in a relatively early stage, which helped to overcome certain limitations of cranial ultrasound. Comparative analysis between MRI including T2* gradient echo images, and computed tomography in hemorrhagic stroke has changed the commonly held belief that cranial computed tomography is superior to MRI in this clinical scenario. Susceptibility perfusion MRI and arterial spin labeling methods have been applied successfully in adult strokes; however, their introduction into the pediatric realm has been limited. Finally, the employment of diffusion tensor imaging, magnetic resonance spectroscopy and positron emission tomography technologies have been shown to be useful in predicting the extent of recovery from stroke. Show more

Keywords: Pediatric stroke, computed tomography, magnetic resonance imaging, diffusion weighted imaging, positron emission tomography

DOI: 10.3233/JPN-2010-0403

Citation: Journal of Pediatric Neurology, vol. 8, no. 3, pp. 267-281, 2010

Authors: Rajpurkar, Madhvi | Lusher, Jeanne M.

Article Type: Research Article

Abstract: Pediatric stroke is a heterogeneous disorder and is associated with significant morbidity and mortality in children. The role of thrombophilia is becoming increasingly important in the pathogenesis of stroke but its effect on clinical outcome and recurrence is not yet well defined. This review provides a summary of current knowledge of thrombophilia in pediatric stroke.

Keywords: Pediatric stroke, coagulation abnormalities, thrombophilia

DOI: 10.3233/JPN-2010-0401

Citation: Journal of Pediatric Neurology, vol. 8, no. 3, pp. 283-289, 2010

Authors: Rajamani, Kumar | Sivaswamy, Lalitha

Article Type: Research Article

Abstract: Childhood stroke is being increasingly recognized and is an important cause of long-term disability and morbidity. This review focuses on the vascular causes of ischemic stroke, which are common in children and may form up to two thirds to three quarters of all ischemic strokes. Vascular causes often result in recurrence and hence are important from the point of view of prognosis. Cervicocephalic dissection is an important cause especially in boys and results from extravasation of …blood into the layers of the blood vessel. Moyamoya syndrome is well recognized in all parts of the world and is diagnosed by the characteristic radiographic picture. Migraine associated stroke, radiation vasculopathy and fibromuscular dysplasia will also be discussed. Stroke in children occurs after varicella zoster infection due to focal narrowing of vessels causing a focal vasculopathy. Transient cerebral vasculopathy appears radiographically similar but may have other etiologies. Show more

Keywords: Childhood stroke, vasculopathy, moyamoya, cervicocephalic dissection, transient cerebral arteriopathy, varicella zoster vasculopathy, radiation vasculopathy

DOI: 10.3233/JPN-2010-0409

Citation: Journal of Pediatric Neurology, vol. 8, no. 3, pp. 291-298, 2010

Authors: Serajee, Fatema J. | Sarnaik, Sharada A. | Altinok, Deniz | Huq, A.H.M. Mahbubul

Article Type: Research Article

Abstract: Sickle cell disease (SCD) is the second commonest cause of stroke in the pediatric population. Cerebrovascular complications in SCD may involve large or small vessels and present as large infarctions, intracranial or subarachnoid hemorrhage, moyamoya disease or silent infarcts. Predictors of stroke in SCD include high blood flow velocity on transcranial Doppler, low hemoglobin value, absence of alpha-thalassemia, high white cell count, hypertension, silent brain infarction, and a history of chest crisis. Regular …blood transfusions are used for primary and secondary prevention of stroke in SCD. Other management strategies include stem cell transplantation, and surgery for moyamoya disease. Show more

Keywords: Sickle cell disease, stroke

DOI: 10.3233/JPN-2010-0407

Citation: Journal of Pediatric Neurology, vol. 8, no. 3, pp. 299-310, 2010

Authors: Taraman, Sharief | Jani-Acsadi, Agnes | Tselis, Alexandros

Article Type: Research Article

Abstract: This paper reviews the spectrum of vasculitides that affect the brain, specifically focusing on primary angiitis of the central nervous system (CNS) and how they relate to stroke in the pediatric population. CNS vasculitis accounts for a substantial portion of pediatric stroke. The extent and severity of the stroke is variable. Hemiparesis and encephalopathy occur commonly, but are not specific to CNS vasculitis. The non-specific presentation and results of investigations make diagnosis difficult. Lack of controlled …treatment trials complicates the management. Blood inflammatory markers, cerebrospinal fluid analysis, multiple imaging techniques including conventional angiography, and brain biopsy form the routine workup. Therapeutic modalities including anti-platelet agents, corticosteroids, cyclophosphamide, and other immunomodulatory agents have been used with the vertical line on the right is cutting into the text apparent success, but the evidence is mostly anecdotal. Show more

Keywords: Stroke, vasculitis, angiitis, central nervous system, pediatric

DOI: 10.3233/JPN-2010-0400

Citation: Journal of Pediatric Neurology, vol. 8, no. 3, pp. 311-319, 2010

Authors: Horvath, Rita | Lochmüller, Hanns | Acsadi, Gyula

Article Type: Research Article

Abstract: The central nervous system is particularly vulnerable to certain metabolic abnormalities that may result in energy failure and subsequent neuronal cell death with clinical presentation as strokelike episodes. The mitochondrion and its electron transport chain machinery provide the main source of ATP for neurons and the most frequent causes of metabolic stroke are associated with the disorders of mitochondria. Mitochondrial diseases are a heterogeneous group of conditions affecting different organs of the body with …variable severity. Both inborn errors (e.g. organic acidurias) and mitochondrial cytopathies can lead to stroke by vascular or cytotoxic mechanisms, thereby making a differential diagnosis complicated when using standard clinical investigations or neuroimaging. This article will provide an overview of various metabolic strokes in childhood with a special emphasis on the most frequent mitochondrial diseases. Show more

Keywords: Metabolic, stroke, pediatric, mitochondria

DOI: 10.3233/JPN-2010-0404

Citation: Journal of Pediatric Neurology, vol. 8, no. 3, pp. 321-332, 2010

Authors: Parker, Graham C.

Article Type: Research Article

Abstract: Cerebral stroke can cause permanent neurological damage, behavioral incapacity and is associated with a high personal and financial cost. Therapeutic options are severely limited. In the past 10 years there has been an explosion of research interest in how a variety of stem cell populations respond in animal models of stroke. Manipulation of endogenous and exogenously introduced stem cells has provided a preponderance of information on how stem cells may improve aspects of cellular and functional …recovery following largely ischemic models of stroke. These in turn have led the way to the initiation of clinical trials. Show more

Keywords: Stem cells, therapy, stroke, cerebral ischemia

DOI: 10.3233/JPN-2010-0408

Citation: Journal of Pediatric Neurology, vol. 8, no. 3, pp. 333-341, 2010