Stroke in children with cardiac disease: report from the International Pediatric Stroke Study Group Symposium

Adriane J Sinclair¹, Christine K Fox², Rebecca N Ichord³, Christopher S Almond⁴, Timothy J Bernard⁵, Lauren A Beslow⁶, Anthony K C Chan⁷, Michael Cheung⁸, Gabrielle deVeber¹, Michael M Dowling⁹, Neil Friedman¹⁰, Therese M Giglia¹¹, Kristin P Guilliams¹², Tilman Humpl¹³, Daniel J Licht³, Mark T Mackay¹⁴, Lori C Jordan¹⁵

Affiliations

¹ Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
² Department of Neurology, University of California, San Francisco, San Francisco, California.
³ Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
⁴ Department of Pediatrics, Stanford University, Lucile Packard Children's Hospital, Palo Alto, California.
⁵ Pediatrics, Neurology and Child Neurology, University of Colorado, Aurora, Colorado.
⁶ Department of Pediatric Neurology, Yale University School of Medicine, New Haven, Connecticut.
⁷ Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada.
⁸ Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Parkville, Victoria, Australia.
⁹ Department of Pediatrics and Neurology, UT Southwestern Medical Center, Dallas, Texas.
¹⁰ Center for Pediatric Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
¹¹ Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
¹² Division of Pediatric Neurology, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri; Division of Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri.
¹³ Division of Cardiac Critical Care, Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
¹⁴ Department of Neurology, Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia.
¹⁵ Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: lori.jordan@vanderbilt.edu.

PMID: 25532775
PMCID: PMC4936915
DOI: 10.1016/j.pediatrneurol.2014.09.016

Review

Stroke in children with cardiac disease: report from the International Pediatric Stroke Study Group Symposium

Adriane J Sinclair et al. Pediatr Neurol. 2015 Jan.

. 2015 Jan;52(1):5-15.

doi: 10.1016/j.pediatrneurol.2014.09.016. Epub 2014 Oct 5.

Authors

Affiliations

¹ Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
² Department of Neurology, University of California, San Francisco, San Francisco, California.
³ Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
⁴ Department of Pediatrics, Stanford University, Lucile Packard Children's Hospital, Palo Alto, California.
⁵ Pediatrics, Neurology and Child Neurology, University of Colorado, Aurora, Colorado.
⁶ Department of Pediatric Neurology, Yale University School of Medicine, New Haven, Connecticut.
⁷ Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada.
⁸ Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Parkville, Victoria, Australia.
⁹ Department of Pediatrics and Neurology, UT Southwestern Medical Center, Dallas, Texas.
¹⁰ Center for Pediatric Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
¹¹ Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
¹² Division of Pediatric Neurology, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri; Division of Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri.
¹³ Division of Cardiac Critical Care, Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
¹⁴ Department of Neurology, Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia.
¹⁵ Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: lori.jordan@vanderbilt.edu.

PMID: 25532775
PMCID: PMC4936915
DOI: 10.1016/j.pediatrneurol.2014.09.016

Abstract

Background: Cardiac disease is a leading cause of stroke in children, yet limited data support the current stroke prevention and treatment recommendations. A multidisciplinary panel of clinicians was convened in February 2014 by the International Pediatric Stroke Study group to identify knowledge gaps and prioritize clinical research efforts for children with cardiac disease and stroke.

Results: Significant knowledge gaps exist, including a lack of data on stroke incidence, predictors, primary and secondary stroke prevention, hyperacute treatment, and outcome in children with cardiac disease. Commonly used diagnostic techniques including brain computed tomography and ultrasound have low rates of stroke detection, and diagnosis is frequently delayed. The challenges of research studies in this population include epidemiologic barriers to research such as small patient numbers, heterogeneity of cardiac disease, and coexistence of multiple risk factors. Based on stroke burden and study feasibility, studies involving mechanical circulatory support, single ventricle patients, early stroke detection strategies, and understanding secondary stroke risk factors and prevention are the highest research priorities over the next 5-10 years. The development of large-scale multicenter and multispecialty collaborative research is a critical next step. The designation of centers of expertise will assist in clinical care and research.

Conclusions: There is an urgent need for additional research to improve the quality of evidence in guideline recommendations for cardiogenic stroke in children. Although significant barriers to clinical research exist, multicenter and multispecialty collaboration is an important step toward advancing clinical care and research for children with cardiac disease and stroke.

Keywords: arterial ischemic; cardiac; congenital heart disease; stroke.

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Figures

**FIGURE**
Propensity to thrombosis in children with cardiac disease based on Virchow’s triad. *Stasis can occur because of nonpulsatile flow, vessel or chamber dilatation, decreased systolic performance, immobility, arrhythmia, or hyperviscosity. ** ^, *** **** Hypoxemia is thought to activate neutrophils, and via the inflammatory cascade, cause endothelial injury. (The color version of this figure is available in the online edition.)

See this image and copyright information in PMC

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Stroke in children with cardiac disease: report from the International Pediatric Stroke Study Group Symposium

Affiliations

Stroke in children with cardiac disease: report from the International Pediatric Stroke Study Group Symposium

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Molecular Biology Databases