Vascular Imaging Crucial to Predicting Recurring Childhood Stroke

Stroke has increasingly been recognized as a significant cause of childhood physical and mental disability, but few studies have been conducted to examine the risk and predictors of recurrence of strokes in children.

In the March 2007 issue of the journal Pediatrics, a University of California, San Francisco- (UCSF; USA)-led group found that strokes recurred in almost 70% of the children whose vascular imaging studies identified abnormalities, but there was no recurrence of stroke in those children with normal vascular imaging.

Although there currently are no guidelines for the diagnostic assessment of pediatric stroke patients, techniques for imaging the blood vessels to the brain, such as magnetic resonance angiography (MRA), should be standard practice for childhood stroke sufferers, according to the authors.

"Our data demonstrates that these imaging studies can identify those children at highest risk for recurrence with a high rate of accuracy,” said the lead author, Heather Fullerton, M.D., assistant professor of neurology and pediatrics and director of the Pediatric Stroke Center at UCSF Children's Hospital. "Identification of a child at high risk for recurrence on the basis of vascular imaging not only provides prognosis but also an opportunity for risk reduction,” the study reported.

Stroke, also known as a cerebrovascular accident (CVA), occurs when the blood supply to any area of the brain is interrupted. It can result in brain tissue death and the loss of brain function. Arterial ischemic stroke may be caused by a blood clot that forms in the brain (a thrombus) or a blood clot, piece of plaque, or other material that travels to the brain from another location (an embolism).

The vast majority of the 97 children who had strokes later in childhood had first-time strokes. Only three of the children had strokes before the study period or enrolling in the Kaiser Permanente Medical Program. Fifteen of the children who had strokes later in childhood had a recurrent stroke. Thirteen of those 15 children who had recurrent strokes also received vascular imaging. Abnormal vascular imaging predicted recurrence. None of the children with normal vascular imaging had a recurrent stroke, whereas almost two-thirds of those with vascular abnormalities suffered a recurrence within five years.


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