Clinical Diversity of Cerebral Sinovenous Thrombosis and Arterial Ischaemic Stroke in the Neonate: A Surveillance Study

Neonatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Anna-Lisa Sorg ◽  
Mathias Klemme ◽  
Rüdiger von Kries ◽  
Ursula Felderhoff-Müser ◽  
Andreas W. Flemmer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Ischaemic Stroke ◽  
Critically Ill ◽  
Age At Onset ◽  
Age At Diagnosis ◽  
Cerebral Sinovenous Thrombosis ◽  
Cerebral Mri ◽  
Sinovenous Thrombosis ◽  
Arterial Ischaemic Stroke

<b><i>Introduction:</i></b> Relative risk, risk factors, clinical presentation, onset of symptoms, and age at diagnosis differ between arterial ischaemic stroke (AIS) and cerebral sinovenous thrombosis (CSVT) in neonates. Distinguishing these 2 entities in time clinically can be of eminent importance. <b><i>Methods:</i></b> Active surveillance for AIS and CSVT was performed in 345 German paediatric hospitals. Only cases confirmed by cerebral MRI were included in our analysis. Patients with AIS were compared to CSVT cases with regard to age at diagnosis, pattern of clinical symptoms, and risk factors. <b><i>Results:</i></b> Data on 144 AIS and 51 CSVT neonatal cases were collected from 2015 to 2017. The relative risk of AIS was 2.8 (95% CI 2.1; 3.9) times higher than that of CSVT. CSVT patients were more likely to be born premature (CSVT 14/48, 29.2%; AIS 19/140, 13.2%; <i>p</i> = 0.02) and to have signs of perinatal acidosis (e.g., umbilical artery pH ≤ 7.1 30.2% CSVT vs. 13.5% AIS <i>p</i> = 0.01). Generalized seizures and lethargy were more likely to occur in infants with CSVT (<i>p</i> &#x3c; 0.0001). Age at onset of symptoms and at time of diagnoses was shifted to older ages in CSVT (<i>p</i> &#x3c; 0.0001). <b><i>Discussion/Conclusion:</i></b> The risk for AIS is about 3 times higher than that for CSVT in neonates. A higher proportion of critically ill infants in CSVT and a later onset of symptoms may indicate that perinatal and postnatal risk factors are more important for CSVT than for AIS. The data underline the need for an increased awareness of CSVT in critically ill infants.

Paediatric arterial ischaemic stroke and cerebral sinovenous thrombosis

2015 ◽  
Vol 113 (06) ◽  
pp. 1270-1277 ◽  
Author(s):  
Agnese Suppiej ◽  
Chiara Gentilomo ◽  
Paola Saracco ◽  
Stefano Sartori ◽  
Manuela Agostini ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Chronic Diseases ◽  
Early Recognition ◽  
Age At Onset ◽  
Treatment Strategies ◽  
Case Series ◽  
Cerebral Sinovenous Thrombosis ◽  
Time To Diagnosis ◽  
Sinovenous Thrombosis ◽  
Arterial Ischaemic Stroke

SummaryData from large case series of children with cerebral thrombotic events are pivotal to improve prevention, early recognition and treatment of these conditions. The Italian Registry of Pediatric Thrombosis (R. I. T. I.) was established in 2007 by a multidisciplinary team, aiming for a better understanding of neonatal and paediatric thrombotic events in Italy and providing a preliminary source of data for the future development of specific clinical trials and diagnostic-therapeutic protocols. We analysed data relative to the paediatric cerebral thrombotic events of the R. I. T. I. which occurred between January 2007 and June 2012. In the study period, 79 arterial ischaemic stroke (AIS) events (49 in males) and 91 cerebral sinovenous thrombosis (CSVT) events (65 in males) were enrolled in the R. I. T. I. Mean age at onset was 4.5 years in AIS, and 7.1 years in CSVT. Most common modes of presentation were hemiparesis, seizures and speech disturbances in AIS, and headache, seizures and lethargy in CSVT. Most common etiologies were underlying chronic diseases, vasculopathy and cardiopathy in AIS, and underlying chronic diseases and infection in CSVT. Time to diagnosis exceeded 24 hours in 46 % AIS and 59 % CSVT. Overall data from the Italian Registry are in substantial agreement with those from the literature, despite small differences. Among these, a longer time to diagnosis compared to other registries and case series poses the accent to the need of an earlier recognition of paediatric cerebrovascular events in Italy, in order to enable prompt and effective treatment strategies.

scholarly journals Clinical diversity of cerebral sinovenous thrombosis and arterial ischemic stroke in the neonate: a surveillance study.

2020 ◽  
Author(s):  
Anna-Lisa Sorg ◽  
Mathias Klemme ◽  
Rüdiger von Kries ◽  
Ursula Felderhoff-Müser ◽  
Andreas W. Flemmer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Clinical Symptoms ◽  
Age At Onset ◽  
Arterial Ischemic Stroke ◽  
Generalized Seizures ◽  
Cerebral Sinovenous Thrombosis ◽  
Cerebral Mri ◽  
Incidence Risk ◽  
Sinovenous Thrombosis

Abstract Background Incidence, risk factors, clinical presentation, onset of symptoms and age at diagnosis differ between arterial ischemic stroke (AIS) and cerebral sinovenous thrombosis (CSVT) in the neonate. Distinguishing these two entities early and clinically can be of eminent importance. Methods Active surveillance for AIS and CSVT was performed in 345 German pediatric hospitals. Reported cases were validated with questionnaires. Only cases confirmed by cerebral MRI were included in our analysis. Both groups of patients (AIS and CSVT) were compared with regard to age at diagnose, pattern of clinical symptoms and risk factors. Results Data on 144 AIS and 51 CSVT neonatal cases were collected from 2015 to 2017. The relative risk of AIS was 2.8 [95% CI 2.1; 3.9] times higher compared to CSVT. CSVT patients were more likely to be born premature (CSVT 14/48, 29.2%; AIS 19/140, 13.2%; p = 0.02), to have signs of perinatal acidosis (e.g. umbilical artery pH ≤ 7.1 30.2% CSVT vs. 13.5% AIS p = 0.01). Generalized seizures and lethargy were more likely to occur in infants with CSVT (p < 0.0001). Age at onset of symptoms and at time of diagnoses was shifted to older ages in CSVT (p < 0.0001). Conclusion The risk for AIS is about three times higher than for CSVT in neonates. A higher proportion of critically ill infants in CSVT and a later onset of symptoms may indicate that perinatal and postnatal risk factors are more important for CSVT than for AIS. The data point to the need for awareness of CSVT in critical ill infants.

scholarly journals Risk factors for perinatal arterial ischaemic stroke: a large case–control study

2019 ◽  
Vol 62 (4) ◽  
pp. 513-520 ◽  
Author(s):  
Anna‐Lisa Sorg ◽  
Rüdiger Kries ◽  
Mathias Klemme ◽  
Lucia Gerstl ◽  
Raphael Weinberger ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischaemic Stroke ◽  
Case Control Study ◽  
Case Control ◽  
Arterial Ischaemic Stroke ◽  
Control Study ◽  
Large Case

Parental family history of dementia in relation to subclinical brain disease and dementia risk

Neurology ◽  
2017 ◽  
Vol 88 (17) ◽  
pp. 1642-1649 ◽  
Author(s):  
Frank J. Wolters ◽  
Sven J. van der Lee ◽  
Peter J. Koudstaal ◽  
Cornelia M. van Duijn ◽  
Albert Hofman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Genetic Risk ◽  
Brain Mri ◽  
Age At Onset ◽  
Age At Diagnosis ◽  
Parental History ◽  
Dementia Risk ◽  
History Of ◽  
Parental Family

Objective:To determine the association of parental family history with risk of dementia by age at onset and sex of affected parent in a population-based cohort.Methods:From 2000 to 2002, we assessed parental history of dementia in participants without dementia of the Rotterdam Study. We investigated associations of parental history with risk of dementia until 2015, adjusting for demographics, cardiovascular risk factors, and known genetic risk variants. Furthermore, we determined the association between parental history and markers of neurodegeneration and vascular disease on MRI.Results:Of 2,087 participants (mean age 64 years, 55% female), 407 (19.6%) reported a history of dementia in either parent (mean age at diagnosis 79 years). During a mean follow-up of 12.2 years, 142 participants developed dementia. Parental history was associated with risk of dementia independently of known genetic risk factors (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.12–2.48), in particular when parents were diagnosed at younger age (<80 years: HR 2.58, 95% CI 1.61–4.15; ≥80 years: HR 1.01, 95% CI 0.58–1.77). Accordingly, age at diagnosis in probands was highly correlated with age at diagnosis in their parents <80 years (r = 0.57, p = 0.001) but not thereafter (r = 0.17, p = 0.55). Among 1,161 participants without dementia with brain MRI, parental history was related to lower cerebral perfusion and higher burden of white matter lesions and microbleeds. Dementia risk and MRI markers were similar for paternal and maternal history.Conclusions:Parental history of dementia increases risk of dementia, primarily when age at parental diagnosis is <80 years. Unexplained heredity may be attributed in part to cerebral hypoperfusion and small vessel disease. We found no evidence of preferential maternal compared to paternal transmission.

Risk factors for pediatric cerebral sinovenous thrombosis: A case-control study with case validation

2020 ◽  
Vol 194 ◽  
pp. 8-15
Author(s):  
Austin Sellers ◽  
Avner Meoded ◽  
Javier Quintana ◽  
George Jallo ◽  
Ernest Amankwah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Case Control ◽  
Cerebral Sinovenous Thrombosis ◽  
Sinovenous Thrombosis ◽  
Case Validation ◽  
Control Study

Arterial ischaemic stroke in children

2004 ◽  
Vol 92 (10) ◽  
pp. 697-706 ◽  
Author(s):  
Fenella Kirkham ◽  
Guillaume Sébire ◽  
Maja Steinlin ◽  
Ronald Sträter
Keyword(s):  
Risk Factors ◽  
Ischaemic Stroke ◽  
Future Research ◽  
Case Control Studies ◽  
Congenital Heart Malformations ◽  
Clinical Presentations ◽  
Prothrombotic Risk Factors ◽  
Arterial Ischaemic Stroke ◽  
Future Research Directions ◽  
Randomised Controlled

SummaryConditions associated with arterial ischaemic stroke in children include a great variety of diseases and triggers such as congenital heart malformations, sickle cell disease, infections and vasculopathies, although up to 50% are cryptogenic. An abnormal vascular status can be demonstrated by vascular imaging in up to 80% of children with ischaemic stroke, and case control studies demonstrate an association between ischaemic stroke in children and hereditary prothrombotic risk factors and infections such as Varicella. Conventional risk factors such as hypertension and dyslipidaemia may also play a role, and most children have several potential triggers rather than one single cause. This review focuses on clinical presentations, imaging methods, stroke subtypes, underlying conditions including prothrombotic risk factors, outcome and recurrence. Although data from randomised controlled trials, on which clinical practice might be based, are sparse, therapeutic approaches and future research directions are discussed.

Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study

2014 ◽  
Vol 13 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Andrew A Mallick ◽  
Vijeya Ganesan ◽  
Fenella J Kirkham ◽  
Penny Fallon ◽  
Tammy Hedderly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischaemic Stroke ◽  
Population Based ◽  
Population Based Study ◽  
Stroke Incidence ◽  
Arterial Ischaemic Stroke
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