Pediatric Ischemic Stroke: An Infrequent Complication of SARS-CoV-2

Lauren A Beslow¹, Alexandra B Linds², Christine K Fox³, Manoëlle Kossorotoff⁴, Yenny C Zuñiga Zambrano⁵, Marta Hernández-Chávez⁶, Sahar M A Hassanein⁷, Susan Byrne^{8

9}, Ming Lim^{8

10}, Nkechi Maduaka¹¹, Dimitrios Zafeiriou¹², Michael M Dowling¹³, Ryan J Felling¹⁴, Mubeen F Rafay¹⁵, Laura L Lehman¹⁶, Michael J Noetzel¹⁷, Timothy J Bernard¹⁸, Nomazulu Dlamini^{2

19}; International Pediatric Stroke Study Group

Affiliations

¹ Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
² Division of Neurology, Department of Paediatrics, and Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada.
³ Departments of Neurology and Pediatrics, University of California San Francisco, San Francisco, CA.
⁴ French Center for Pediatric Stroke, Pediatric Neurology Department, APHP University Hospital Necker-Enfants Maladies, Paris, France.
⁵ Unit of Pediatric Neurology, Fundación, Hospital de la Misericordia, Bogotá, Colombia.
⁶ Unit of Neurology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
⁷ Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
⁸ Evelina London Children's Hospital, London, UK.
⁹ FutureNeuro, Royal College of Surgeons, Dublin, Ireland.
¹⁰ Faculty of Life Sciences and Medicine, King's College London, London, UK.
¹¹ Paediatric Department, King's College Hospital, London, UK.
¹² Department of Pediatrics, Hippokratio General Hospital, Aristotle University, Thessaloniki, Greece.
¹³ Departments of Pediatrics and Neurology, University of Texas Southwestern Medical Center, Dallas, TX.
¹⁴ Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD.
¹⁵ Section of Neurology, Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada.
¹⁶ Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA.
¹⁷ Departments of Neurology and Pediatrics, Division of Pediatric and Developmental Neurology, Washington University School of Medicine, Neurorehabilitation Program, St. Louis Children's Hospital, St. Louis, MO.
¹⁸ Section of Child Neurology, Children's Hospital Colorado, Departments of Pediatrics and Neurology, Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Aurora, CO.
¹⁹ Department of Paediatrics, University of Toronto, Toronto, ON, Canada.

PMID: 33332607
DOI: 10.1002/ana.25991

Pediatric Ischemic Stroke: An Infrequent Complication of SARS-CoV-2

Lauren A Beslow et al. Ann Neurol. 2021 Apr.

. 2021 Apr;89(4):657-665.

doi: 10.1002/ana.25991. Epub 2021 Jan 28.

Authors

Affiliations

¹ Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
² Division of Neurology, Department of Paediatrics, and Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada.
³ Departments of Neurology and Pediatrics, University of California San Francisco, San Francisco, CA.
⁴ French Center for Pediatric Stroke, Pediatric Neurology Department, APHP University Hospital Necker-Enfants Maladies, Paris, France.
⁵ Unit of Pediatric Neurology, Fundación, Hospital de la Misericordia, Bogotá, Colombia.
⁶ Unit of Neurology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
⁷ Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
⁸ Evelina London Children's Hospital, London, UK.
⁹ FutureNeuro, Royal College of Surgeons, Dublin, Ireland.
¹⁰ Faculty of Life Sciences and Medicine, King's College London, London, UK.
¹¹ Paediatric Department, King's College Hospital, London, UK.
¹² Department of Pediatrics, Hippokratio General Hospital, Aristotle University, Thessaloniki, Greece.
¹³ Departments of Pediatrics and Neurology, University of Texas Southwestern Medical Center, Dallas, TX.
¹⁴ Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD.
¹⁵ Section of Neurology, Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada.
¹⁶ Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA.
¹⁷ Departments of Neurology and Pediatrics, Division of Pediatric and Developmental Neurology, Washington University School of Medicine, Neurorehabilitation Program, St. Louis Children's Hospital, St. Louis, MO.
¹⁸ Section of Child Neurology, Children's Hospital Colorado, Departments of Pediatrics and Neurology, Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Aurora, CO.
¹⁹ Department of Paediatrics, University of Toronto, Toronto, ON, Canada.

PMID: 33332607
DOI: 10.1002/ana.25991

Abstract

Objective: Severe complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) include arterial ischemic stroke (AIS) in adults and multisystem inflammatory syndrome in children. Whether stroke is a frequent complication of pediatric SARS-CoV-2 is unknown. This study aimed to determine the proportion of pediatric SARS-CoV-2 cases with ischemic stroke and the proportion of incident pediatric strokes with SARS-CoV-2 in the first 3 months of the pandemic in an international cohort.

Methods: We surveyed 61 international sites with pediatric stroke expertise. Survey questions included: numbers of hospitalized pediatric (≤ 18 years) patients with SARS-CoV-2; numbers of incident neonatal and childhood ischemic strokes; frequency of SARS-CoV-2 testing for pediatric patients with stroke; and numbers of stroke cases positive for SARS-CoV-2 from March 1 to May 31, 2020.

Results: Of 42 centers with SARS-CoV-2 hospitalization numbers, 8 of 971 (0.82%) pediatric patients with SARS-CoV-2 had ischemic strokes. Proportions of stroke cases positive for SARS-CoV-2 from March to May 2020 were: 1 of 108 with neonatal AIS (0.9%), 0 of 33 with neonatal cerebral sinovenous thrombosis (CSVT; 0%), 6 of 166 with childhood AIS (3.6%), and 1 of 54 with childhood CSVT (1.9%). However, only 30.5% of neonates and 60% of children with strokes were tested for SARS-CoV-2. Therefore, these proportions represent 2.9, 0, 6.1, and 3.0% of stroke cases tested for SARS-CoV-2. Seven of 8 patients with SARS-CoV-2 had additional established stroke risk factors.

Interpretation: As in adults, pediatric stroke is an infrequent complication of SARS-CoV-2, and SARS-CoV-2 was detected in only 4.6% of pediatric patients with ischemic stroke tested for the virus. However, < 50% of strokes were tested. To understand the role of SARS-CoV-2 in pediatric stroke better, SARS-CoV-2 testing should be considered in pediatric patients with stroke as the pandemic continues. ANN NEUROL 2021;89:657-665.

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Comment in

Cerebral Infarctions in an Infant With COVID-19 Delta Variant Infection and Disseminated Tuberculosis.
Fraser S, Ellsworth M, Perez N, Hamilton H, Fletcher S, Brown D, Srivaths L. Fraser S, et al. Pediatr Neurol. 2022 Jan;126:112-113. doi: 10.1016/j.pediatrneurol.2021.10.014. Epub 2021 Oct 25. Pediatr Neurol. 2022. PMID: 34839267 Free PMC article. No abstract available.

References

1. Li Y, Li M, Wang M, et al. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke Vasc Neurol 2020;5:279-284.
1. Beyrouti R, Adams ME, Benjamin L, et al. Characteristics of ischaemic stroke associated with COVID-19. J Neurol Neurosurg Psychiatry 2020;91:889-891.
1. Oxley TJ, Mocco J, Majidi S, et al. Large-vessel stroke as a presenting feature of Covid-19 in the young. N Engl J Med 2020;382:e60.
1. Riphagen S, Gomez X, Gonzalez-Martinez C, et al. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020;395:1607-1608.
1. Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med 2020;383:334-346.

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Pediatric Ischemic Stroke: An Infrequent Complication of SARS-CoV-2

Affiliations

Pediatric Ischemic Stroke: An Infrequent Complication of SARS-CoV-2

Authors

Affiliations

Abstract

Comment in

References

MeSH terms

Supplementary concepts

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials

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