CLINICAL AND RADIOLOGICAL RECURRENCE AFTER CHILDHOOD STROKE

Rates and risk factors for clinical and radiological recurrence might inform secondary prevention strategies for childhood stroke. 212 patients with arterial ischaemic stroke (AIS; 35 sickle cell disease (SCD), 26 cardiac, 6 immunodeficency, 30 other prior diagnosis, 133 previously healthy) were identified in one centre, undergoing repeat neuroimaging after clinical recurrence or, if asymptomatic, >1 year after first AIS. Relationships between risk factors and clinical and radiological recurrence were explored with Cox and logistic regression respectively. Seventy-nine had clinical recurrence (33 stroke, 46 transient ischemic attack (TIA)), one day – 11.5 years (median 267 days) later; after 5 years 59% (51, 67%) were recurrence-free. Angiographic moyamoya and prior diagnosis were independently associated with clinical recurrence in the whole group. Genetic thrombophilia was associated with clinical recurrence in previously healthy patients, independently of moyamoya. 60/179 patients with repeat neuroimaging had radiological re-infarction, clinically covert in 20. Previous TIA, leukocytosis, bilateral infarction, and immunodeficiency were independently associated with re-infarction; the first two were independently associated with covert re-infarction. Pooled data from Canada, Germany and the UK confirm that vascular disease and thrombophilia are independent risk factors for recurrent AIS. Recurrent venous thrombosis is less common, particularly in young children, and has different risk factors. Of 96 patients with SCD, 45 had had a further event (23 TIA, 22 stroke) and in multivariable Cox regression, moyamoya and lack of a prodrome prior to the first event were independent risk factors for recurrence. Clinical and radiological recurrence are common after childhood stroke. Recurrent AIS is associated with prior diagnosis, moyamoya and, in previously healthy patients, with genetic thrombophilia. As well as pre-existing pathology, persistent leukocytosis and immunodeficiency are risk factors for radiological recurrence, suggesting a potential role for chronic, perhaps subclinical, infection. Recurrence occurs in SCD despite chronic transfusion and in venous sinus thrombosis.