Assessing underlying risk factors for childhood stroke is important to survival and quality of life. New findings suggest that recent minor acute infections of the ear, upper respiratory tract, and urinary tract can pose a high risk of ischemic stroke in children. These are common pediatric occurrences, so how can you identify patients at risk?
Common infections including minor acute infections of the ear, upper respiratory tract, and urinary tract can pose a high risk of ischemic stroke in children, with the highest risk occurring in the first week after an infection. Acute infections are more concerning for triggering stroke than chronic infections over time.
Aware that infections are associated with arterial ischemic stroke in adults and with exposure to multiple infections possibly contributing to atherosclerosis, investigators wanting to know whether timing or burden of infection is a predictor of childhood ischemic stroke reviewed 2.5 million children younger than 20 years and identified 126 childhood ischemic stroke cases that were then age-matched with controls.
Researchers discovered that 29% of the children who had suffered a stroke had a medical encounter for infection in the 2 days before the stroke versus 1% of controls during the same dates. In the 3- to 7-day window, 13% of children had an infection compared with 2% of controls. The elevated risk of stroke did not persist after the first month of infection. Findings between girls and boys or ethnic groups were similar.
Infectious visits within the prior 2 years were documented in 79% of cases of stroke and 62% of controls.
The researchers note that most previously healthy children with an ischemic stroke have a disease of the blood vessels to the brain and are at highest risk of recurrent stroke. They say their findings may provide insight into why children develop arteriopathy, the inflammatory process that results from an infection, which may lead to stroke by causing vascular injury.
“We suspect that there are rare genetic factors that may place some children at risk for this uncommon effect of common infections,” said Heather Fullerton, MD, the study’s principal investigator, who presented the abstract at the International Stroke Conference 2012 in New Orleans.
The risk for ischemic stroke is low in children in the study’s age range, with a frequently cited finding of 2.3 per 100,000 children per year.
Standard treatment for ischemic stroke in children is blood thinners, but the researchers say that future research should focus on the potential role for anti-inflammatory medications in preventing the recurrence of stroke in this population.