Neuropediatrics 2006; 37 - THP169
DOI: 10.1055/s-2006-945992

CLASSIFICATION AND EVOLUTION OF CEREBRAL ARTERIOPATHIES IN CHILDHOOD ARTERIAL ISCHAEMIC STROKE

N Danchaivijitr 1, T Cox 1, D Saunders 1, V Ganesan 1
  • 1Institute of Child Health, University College London, London, United Kingdom

Objectives: (i) To apply a recently proposed classification of childhood cerebral arteriopathy to a clinical cohort of children with arterial ischaemic stroke (AIS) (ii) To investigate the relationship between arteriopathy evolution and AIS recurrence.

Methods: Serial magnetic resonance angiograms from children with first AIS were evaluated and arteriopathy, where present, was categorised. Severity of arteriopathy was graded on initial and follow-up imaging.

Results: Fifty children identified were included (30 male, median age at AIS 49 months). Other risk factors for childhood AIS were identified in 40 (1 other risk factor in 28 and 2 other risk factors in 12). All had middle cerebral artery (MCA) territory infarction. Arteriopathy affected 72 arteries (most commonly MCA) in 43. Diagnostic classification was: transient cerebral arteriopathy in 24, chronic cerebral arteriopathy in 11, arterial dissection in 3, primary moyamoya in 1, possible moyamoya in 2, dysplastic arteriopathy in 1 and cerebral vasculitis in 1. Median duration of clinical follow-up was 38 months (range 1–120 months) and to final reimaging was 22 months (0.5–105 months). Five children had recurrent clinical TIA or AIS, with re-infarction in 4; a further child had clinically silent re-infarction. Twelve children (24%), including 4 of those with recurrence, had progressive arteriopathy. Arteriopathy improved in 24 cases (of whom one had recurrent TIAs) and was stable in 7. MRA remained normal in all seven patients with initially normal MRA; one had a recurrent stroke. In univariate logistic regression analyses, only progression of arteriopathy (compared with stable or improved) was significantly associated with recurrence (OR 9, 95% confidence intervals 1.4, 58, p=0.02). This association remained significant in a multivariate model (OR 53.9, 95% CI 1.5, 2010, p=0.03).

Conclusion: Progressive arteriopathy is significantly associated with recurrence of childhood AIS; a causal link between the two remains to be established. Identification of patients with progressive arteriopathy as a high-risk group has important implications for impending clinical trials of secondary prevention in paediatric stroke.