International Prevalence and Mechanisms of SARS-CoV-2 in Childhood Arterial Ischemic Stroke During the COVID-19 Pandemic

Lauren A Beslow¹, Shannon C Agner², Jonathan D Santoro³, Dipak Ram⁴, Jenny L Wilson⁵, Dana Harrar⁶, Brian Appavu⁷, Stuart M Fraser⁸, Thomas Rossor⁹, Marcela D Torres¹⁰, Manoëlle Kossorotoff¹¹, Yenny C Zuñiga Zambrano¹², Marta Hernández-Chávez¹³, Sahar M A Hassanein¹⁴, Dimitrios Zafeiriou¹⁵, Michael M Dowling¹⁶, Ilona Kopyta¹⁷, Nicholas V Stence¹⁸, Timothy J Bernard¹⁹, Nomazulu Dlamini²⁰; International Pediatric Stroke Study Group

Collaborators, Affiliations

Collaborators

International Pediatric Stroke Study Group:
Ahmed Abd El-Hamid Rihan, Maha Mohammed, Moustafa Farid, Wessam S S Guergues, Mohamed O E Babiker, Oded Hochberg, Paola Saracco, Thomas Main, Andrew Mallick, Selina Kala, Bryan L Philbrook, Kartik Reddy, Rebecca N Ichord, Evelyn K Shih, Rachel P Pearson, Mubeen F Rafay, Mukta Sharma, Mary Allen Staat, Sudhakar Vadivelu, Marvid Duarte, Mary Suzanne Whitworth, Manish Parakh, Kevin Meesters, Charles-Joris Roud, Marianne Leruez-Ville, Vijeya Ganesan, Laura L Lehman, Michael Rivkin, Zulma Hernandez, Fernanda Balut, Maria Celeste Buompadre, Heidy J Gómez Naranjo, Veronica Gonzalez Alvarez, Nihal Bakeer, Stephanie Garrison, Christopher Belcher, Lorie Miller, Maria Whitmore, Giulia Amico, Mariasavina Severino, Marta Bertamino, Sara Signa, Lisa R Sun, Ryan J Felling, Pawan Kashyape, Lucia Gerstl, Gordana Kovacevic, Anna Basu, Yusri Taha, Warren D Lo, Maggie L Y Yau, Deirdre Peake, Kim Stevenson, Samson Gwer, Andrea Andrade, Catherine Amlie-Lefond, Jacqueline Lee-Eng, Sarah Lee, Janette Mailo, Moran Hausman-Kedem, Kamna Jaiswal, Kellie Brown, Belinda Stojanovski, Mark T Mackay, Adriana Carolina Vargas Nino, Daune McGregor, Gabrielle deVeber, Ishvinder Bhathal, N P Liza Pulcine, Mahendra Moharir, Bruce Bjornson, Danny H C Kim, Adam Kirton, Amalia Floer, Christine K Fox, Christiana Smith-Anderson, Kelly Wilt, Vivian Thompson, Michael L Chang, Marilyn Tan, Lori C Jordan, Annette E Grefe, Kristin Guilliams, Michael J Noetzel

Affiliations

¹ Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania (L.A.B.).
² Division of Pediatric and Developmental Neurology, St. Louis Children's Hospital, Washington University School of Medicine, MO (S.C.A.).
³ Division of Neurology, Children's Hospital Los Angeles, Department of Neurology, Keck School of Medicine at USC, CA (J.D.S.).
⁴ Department of Paediatric Neurology, Royal Manchester Children's Hospital, England, United Kingdom (D.R.).
⁵ Department of Pediatrics, Division of Pediatric Neurology, Oregon Health & Science University, Portland (J.L.W.).
⁶ Division of Neurology, Children's National Medical Center, Washington' D.C. (D.H.).
⁷ Divison of Neurology, Phoenix Children's Hospital, University of Arizona College of Medicine - Phoenix (B.A.).
⁸ Division of Neurology, Children's Memorial Hermann Hospital, Houston' TX (S.M.F.).
⁹ Evelina London Children's Hospital, England, United Kingdom (T.R.).
¹⁰ Division of Hematology, Cook Children's Medical Center, Fort Worth, TX (M.D.T.).
¹¹ French Center for Pediatric Stroke, Pediatric Neurology Department, APHP University Hospital Necker-Enfants maladies, Paris, France (M.K.).
¹² Unit of Pediatric Neurology, HOMI Fundación Hospital Pediátrico la Misericordia, Bogotá, Colombia (Y.C.Z.Z.).
¹³ Unit of Pediatric Neurology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago (M.H.-C.).
¹⁴ Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt (S.M.A.H.).
¹⁵ Department of Pediatrics, Hippokratio General Hospital, Aristotle University, Thessaloniki, Greece (D.Z.).
¹⁶ Departments of Pediatrics and Neurology, University of Texas Southwestern Medical Center, Dallas (M.M.D.).
¹⁷ Department of Child Neurology, Medical University of Silesia in Katowice, Poland (I.K.).
¹⁸ Section of Pediatric Radiology, Children's Hospital Colorado, Department of Radiology, University of Colorado School of Medicine' Aurora (N.V.S.).
¹⁹ Section of Child Neurology, Children's Hospital Colorado, Departments of Pediatrics and Neurology, Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Aurora (T.J.B.).
²⁰ Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Child Health Evaluative Sciences Program, University of Toronto, ON, Canada (N.D.).

PMID: 35380052
PMCID: PMC9311284
DOI: 10.1161/STROKEAHA.121.038250

International Prevalence and Mechanisms of SARS-CoV-2 in Childhood Arterial Ischemic Stroke During the COVID-19 Pandemic

Lauren A Beslow et al. Stroke. 2022 Aug.

. 2022 Aug;53(8):2497-2503.

doi: 10.1161/STROKEAHA.121.038250. Epub 2022 Apr 5.

Authors

Collaborators

International Pediatric Stroke Study Group:
Ahmed Abd El-Hamid Rihan, Maha Mohammed, Moustafa Farid, Wessam S S Guergues, Mohamed O E Babiker, Oded Hochberg, Paola Saracco, Thomas Main, Andrew Mallick, Selina Kala, Bryan L Philbrook, Kartik Reddy, Rebecca N Ichord, Evelyn K Shih, Rachel P Pearson, Mubeen F Rafay, Mukta Sharma, Mary Allen Staat, Sudhakar Vadivelu, Marvid Duarte, Mary Suzanne Whitworth, Manish Parakh, Kevin Meesters, Charles-Joris Roud, Marianne Leruez-Ville, Vijeya Ganesan, Laura L Lehman, Michael Rivkin, Zulma Hernandez, Fernanda Balut, Maria Celeste Buompadre, Heidy J Gómez Naranjo, Veronica Gonzalez Alvarez, Nihal Bakeer, Stephanie Garrison, Christopher Belcher, Lorie Miller, Maria Whitmore, Giulia Amico, Mariasavina Severino, Marta Bertamino, Sara Signa, Lisa R Sun, Ryan J Felling, Pawan Kashyape, Lucia Gerstl, Gordana Kovacevic, Anna Basu, Yusri Taha, Warren D Lo, Maggie L Y Yau, Deirdre Peake, Kim Stevenson, Samson Gwer, Andrea Andrade, Catherine Amlie-Lefond, Jacqueline Lee-Eng, Sarah Lee, Janette Mailo, Moran Hausman-Kedem, Kamna Jaiswal, Kellie Brown, Belinda Stojanovski, Mark T Mackay, Adriana Carolina Vargas Nino, Daune McGregor, Gabrielle deVeber, Ishvinder Bhathal, N P Liza Pulcine, Mahendra Moharir, Bruce Bjornson, Danny H C Kim, Adam Kirton, Amalia Floer, Christine K Fox, Christiana Smith-Anderson, Kelly Wilt, Vivian Thompson, Michael L Chang, Marilyn Tan, Lori C Jordan, Annette E Grefe, Kristin Guilliams, Michael J Noetzel

Affiliations

¹ Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania (L.A.B.).
² Division of Pediatric and Developmental Neurology, St. Louis Children's Hospital, Washington University School of Medicine, MO (S.C.A.).
³ Division of Neurology, Children's Hospital Los Angeles, Department of Neurology, Keck School of Medicine at USC, CA (J.D.S.).
⁴ Department of Paediatric Neurology, Royal Manchester Children's Hospital, England, United Kingdom (D.R.).
⁵ Department of Pediatrics, Division of Pediatric Neurology, Oregon Health & Science University, Portland (J.L.W.).
⁶ Division of Neurology, Children's National Medical Center, Washington' D.C. (D.H.).
⁷ Divison of Neurology, Phoenix Children's Hospital, University of Arizona College of Medicine - Phoenix (B.A.).
⁸ Division of Neurology, Children's Memorial Hermann Hospital, Houston' TX (S.M.F.).
⁹ Evelina London Children's Hospital, England, United Kingdom (T.R.).
¹⁰ Division of Hematology, Cook Children's Medical Center, Fort Worth, TX (M.D.T.).
¹¹ French Center for Pediatric Stroke, Pediatric Neurology Department, APHP University Hospital Necker-Enfants maladies, Paris, France (M.K.).
¹² Unit of Pediatric Neurology, HOMI Fundación Hospital Pediátrico la Misericordia, Bogotá, Colombia (Y.C.Z.Z.).
¹³ Unit of Pediatric Neurology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago (M.H.-C.).
¹⁴ Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt (S.M.A.H.).
¹⁵ Department of Pediatrics, Hippokratio General Hospital, Aristotle University, Thessaloniki, Greece (D.Z.).
¹⁶ Departments of Pediatrics and Neurology, University of Texas Southwestern Medical Center, Dallas (M.M.D.).
¹⁷ Department of Child Neurology, Medical University of Silesia in Katowice, Poland (I.K.).
¹⁸ Section of Pediatric Radiology, Children's Hospital Colorado, Department of Radiology, University of Colorado School of Medicine' Aurora (N.V.S.).
¹⁹ Section of Child Neurology, Children's Hospital Colorado, Departments of Pediatrics and Neurology, Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Aurora (T.J.B.).
²⁰ Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Child Health Evaluative Sciences Program, University of Toronto, ON, Canada (N.D.).

PMID: 35380052
PMCID: PMC9311284
DOI: 10.1161/STROKEAHA.121.038250

Abstract

Background: Data from the early pandemic revealed that 0.62% of children hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had an acute arterial ischemic stroke (AIS). In a larger cohort from June 2020 to December 2020, we sought to determine whether our initial point estimate was stable as the pandemic continued and to understand radiographic and laboratory data that may clarify mechanisms of pediatric AIS in the setting of SARS-CoV-2.

Methods: We surveyed international sites with pediatric stroke expertise to determine numbers of hospitalized SARS-CoV-2 patients <18 years, numbers of incident AIS cases among children (29 days to <18 years), frequency of SARS-CoV-2 testing for children with AIS, and numbers of childhood AIS cases positive for SARS-CoV-2 June 1 to December 31, 2020. Two stroke neurologists with 1 neuroradiologist determined whether SARS-CoV-2 was the main stroke risk factor, contributory, or incidental.

Results: Sixty-one centers from 21 countries provided AIS data. Forty-eight centers (78.7%) provided SARS-CoV-2 hospitalization data. SARS-CoV-2 testing was performed in 335/373 acute AIS cases (89.8%) compared with 99/166 (59.6%) in March to May 2020, P<0.0001. Twenty-three of 335 AIS cases tested (6.9%) were positive for SARS-CoV-2 compared with 6/99 tested (6.1%) in March to May 2020, P=0.78. Of the 22 of 23 AIS cases with SARS-CoV-2 in whom we could collect additional data, SARS-CoV-2 was the main stroke risk factor in 6 (3 with arteritis/vasculitis, 3 with focal cerebral arteriopathy), a contributory factor in 13, and incidental in 3. Elevated inflammatory markers were common, occurring in 17 (77.3%). From centers with SARS-CoV-2 hospitalization data, of 7231 pediatric patients hospitalized with SARS-CoV-2, 23 had AIS (0.32%) compared with 6/971 (0.62%) from March to May 2020, P=0.14.

Conclusions: The risk of AIS among children hospitalized with SARS-CoV-2 appeared stable compared with our earlier estimate. Among children in whom SARS-CoV-2 was considered the main stroke risk factor, inflammatory arteriopathies were the stroke mechanism.

Keywords: arteriopathy; child; hospitalization; ischemic stroke; risk factors.

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References

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International Prevalence and Mechanisms of SARS-CoV-2 in Childhood Arterial Ischemic Stroke During the COVID-19 Pandemic

Collaborators

Affiliations

International Prevalence and Mechanisms of SARS-CoV-2 in Childhood Arterial Ischemic Stroke During the COVID-19 Pandemic

Authors

Collaborators

Affiliations

Abstract

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous