Observational Study

. 2020 Jan 28;94(4):e337-e344.

doi: 10.1212/WNL.0000000000008837. Epub 2019 Dec 19.

Comparative study of posterior and anterior circulation stroke in childhood: Results from the International Pediatric Stroke Study

Collaborators, Affiliations

Collaborators

IPSS Study Group:
Steve Ashwal, Gabrielle deVeber, Donna Ferriero, Heather Fullerton, Rebecca Ichord, Fenella Kirkham, John K Lynch, Finbar O’Callaghan, Steve Pavlakis, Guillaume Sebire, Andrew Willan, Gabrielle deVeber, Michael Dowling, Mark Mackay, Marta Hernandez Chavez, Timothy Bernard, Ulrike Nowak-Gottl, Susan Benedict, Mubeen Rafay, Jerome Yager, Warren Lo, Manish Parakh, Adam Kirton, Rebecca Ichord, Maja Steinlin, Jessica Carpenter, Michael Rivkin, Max Wiznitzer, Finbar O’Callaghan, Li Kan, Dimitirios Zafeiriou, Heather Fullerton, Bruce Bjornson, Lori Jordan, Stephen Ashwal, Marcela Torres, Anneli Kolk, Monica Troncoso, Harry Whelan, Steven Pavlakis, Anthony Chan, Ilona Kopyta, Abdalla Abdalla, Terrence Gerard, Meredith Golomb, Peter Humphreys, Michael Noetzel, Geoffrey Heyer, Catherine Amlie-Lefond, Ann Yeh, Paola Pergami, Francesco Cardona, Gordana Kovacevic, Vijeya Ganesan, Jorina Elbers, Neil Friedman, Virginia Wong, Nana Tatishvili, Sally Sultan, Lisa Abraham, Veronica Gonzalez, Luigi Titomanlio, Montri Saengpattrachai, Norma B. Lerner, Hal Crosswell, Carolina Oliviera, Lucila Andrade Alveal, Ryan Felling, Maayke Hunfeld, Diana Altuna, Nassim Zecavati, David Buckley, Marcel Deray, Sahar Hassanein, Vesna Brankovic-Sreckovic, Anaita Hegde, Deepti Raybagkar, Guillaume Sebire, Christina Miteff, John Condie, Chaouki Khoury, Shannon Carpenter, Susanne Holzhauer, Patricia Garcia Soler, Lisa Nassif El-Hakam, Luis Conto, Jose Francisco Vilavedra, Barry Kosofsky, Yang Guang, J. Michael Taylor, Neil Goldenberg, Adrian Toma, Lauren A. Beslow, Mark Wainwright, Frederico Xavier, Eric Grabowski, Ruth Nass, Jenny Wilson

Affiliations

¹ From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia. barbara.goeggelsimonetti@insel.ch.
² From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia.

PMID: 31857436
PMCID: PMC7978473
DOI: 10.1212/WNL.0000000000008837

Observational Study

Comparative study of posterior and anterior circulation stroke in childhood: Results from the International Pediatric Stroke Study

Barbara Goeggel Simonetti et al. Neurology. 2020.

. 2020 Jan 28;94(4):e337-e344.

doi: 10.1212/WNL.0000000000008837. Epub 2019 Dec 19.

Collaborators

IPSS Study Group:
Steve Ashwal, Gabrielle deVeber, Donna Ferriero, Heather Fullerton, Rebecca Ichord, Fenella Kirkham, John K Lynch, Finbar O’Callaghan, Steve Pavlakis, Guillaume Sebire, Andrew Willan, Gabrielle deVeber, Michael Dowling, Mark Mackay, Marta Hernandez Chavez, Timothy Bernard, Ulrike Nowak-Gottl, Susan Benedict, Mubeen Rafay, Jerome Yager, Warren Lo, Manish Parakh, Adam Kirton, Rebecca Ichord, Maja Steinlin, Jessica Carpenter, Michael Rivkin, Max Wiznitzer, Finbar O’Callaghan, Li Kan, Dimitirios Zafeiriou, Heather Fullerton, Bruce Bjornson, Lori Jordan, Stephen Ashwal, Marcela Torres, Anneli Kolk, Monica Troncoso, Harry Whelan, Steven Pavlakis, Anthony Chan, Ilona Kopyta, Abdalla Abdalla, Terrence Gerard, Meredith Golomb, Peter Humphreys, Michael Noetzel, Geoffrey Heyer, Catherine Amlie-Lefond, Ann Yeh, Paola Pergami, Francesco Cardona, Gordana Kovacevic, Vijeya Ganesan, Jorina Elbers, Neil Friedman, Virginia Wong, Nana Tatishvili, Sally Sultan, Lisa Abraham, Veronica Gonzalez, Luigi Titomanlio, Montri Saengpattrachai, Norma B. Lerner, Hal Crosswell, Carolina Oliviera, Lucila Andrade Alveal, Ryan Felling, Maayke Hunfeld, Diana Altuna, Nassim Zecavati, David Buckley, Marcel Deray, Sahar Hassanein, Vesna Brankovic-Sreckovic, Anaita Hegde, Deepti Raybagkar, Guillaume Sebire, Christina Miteff, John Condie, Chaouki Khoury, Shannon Carpenter, Susanne Holzhauer, Patricia Garcia Soler, Lisa Nassif El-Hakam, Luis Conto, Jose Francisco Vilavedra, Barry Kosofsky, Yang Guang, J. Michael Taylor, Neil Goldenberg, Adrian Toma, Lauren A. Beslow, Mark Wainwright, Frederico Xavier, Eric Grabowski, Ruth Nass, Jenny Wilson

Affiliations

¹ From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia. barbara.goeggelsimonetti@insel.ch.
² From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia.

PMID: 31857436
PMCID: PMC7978473
DOI: 10.1212/WNL.0000000000008837

Abstract

Objective: To compare risk factors, clinical presentation, and outcomes after posterior circulation arterial ischemic stroke (PCAIS) and anterior circulation arterial ischemic stroke (ACAIS) in neonates and children.

Methods: In this international multicenter observational study including neonates and children up to 18 years of age with arterial ischemic stroke (AIS), we compared clinical and radiologic features according to stroke location.

Results: Of 2,768 AIS cases, 507 (18%) were located in the posterior circulation, 1,931 (70%) in the anterior circulation, and 330 (12%) involved both. PCAIS was less frequent in neonates compared to children (8.8% vs 22%, p < 0.001). Children with PCAIS were older than children with ACAIS (median age 7.8 [interquartile range (IQR) 3.1-14] vs 5.1 [IQR 1.5-12] years, p < 0.001), and more often presented with headache (54% vs 32%, p < 0.001) and a lower Pediatric NIH Stroke Scale score (4 [IQR 2-8] vs 8 [IQR 3-13], p = 0.001). Cervicocephalic artery dissections (CCAD) were more frequent (20% vs 8.5%, p < 0.001), while cardioembolic strokes were less frequent (19% vs 32%, p < 0.001) in PCAIS. Case fatality rates were equal in both groups (2.9%). PCAIS survivors had a better outcome (normal neurologic examination at hospital discharge in 29% vs 21%, p = 0.002) than ACAIS survivors, although this trend was only observed in children and not in neonates.

Conclusion: PCAIS is less common than ACAIS in both neonates and children. Children with PCAIS are older and have a higher rate of CCAD, lower clinical stroke severity, and better outcome than children with ACAIS.

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Figures

**Figure. Age distribution according to stroke territory**
ACAIS = anterior circulation arterial ischemic stroke; PCAIS = posterior circulation arterial ischemic stroke.

See this image and copyright information in PMC

Comment in

Posterior circulation strokes in children: Fearsome or not?
Jordan LC, Jacobs BS. Jordan LC, et al. Neurology. 2020 Jan 28;94(4):149-150. doi: 10.1212/WNL.0000000000008832. Epub 2019 Dec 19. Neurology. 2020. PMID: 31857434 No abstract available.
Pediatric ischemic stroke.
Morotti A, Mazzacane F, Leuci E. Morotti A, et al. J Neurol. 2020 Apr;267(4):1221-1222. doi: 10.1007/s00415-020-09779-3. J Neurol. 2020. PMID: 32157384 No abstract available.

References

1. Ganesan V, Chong WK, Cox TC, Chawda SJ, Prengler M, Kirkham FJ. Posterior circulation stroke in childhood: risk factors and recurrence. Neurology 2002;59:1552–1556. - PubMed
1. Mackay MT, Prabhu SP, Coleman L. Childhood posterior circulation arterial ischemic stroke. Stroke 2010;41:2201–2209. - PubMed
1. McCrea N, Saunders D, Bagkeris E, Chitre M, Ganesan V. Diagnosis of vertebral artery dissection in childhood posterior circulation arterial ischaemic stroke. Dev Med Child Neurol 2016;58:63–69. - PubMed
1. Carey S, Wrogemann J, Booth FA, Rafay MF. Epidemiology, clinical presentation, and prognosis of posterior circulation ischemic stroke in children. Pediatr Neurol 2017;74:41–50. - PubMed
1. Grunt S, Mazenauer L, Buerki SE, et al. . Incidence and outcomes of symptomatic neonatal arterial ischemic stroke. Pediatrics 2015;135:e1220–1228. - PubMed

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Comparative study of posterior and anterior circulation stroke in childhood: Results from the International Pediatric Stroke Study

Collaborators

Affiliations

Comparative study of posterior and anterior circulation stroke in childhood: Results from the International Pediatric Stroke Study

Authors

Collaborators

Affiliations

Abstract

Figures

Comment in

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical