Cardiac Myxoma as a Rare Cause of Pediatric Arterial Ischemic Stroke: Case Report and Literature Review

2020 ◽  
Vol 51 (06) ◽  
pp. 389-396
Author(s):  
Clarissa Tona ◽  
Margherita Nosadini ◽  
Maria F. Pelizza ◽  
Jacopo N. Pin ◽  
Laura Baggio ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Literature Review ◽  
Clinical Symptoms ◽  
Cardiac Myxoma ◽  
Neurological Deficits ◽  
Healthy Children ◽  
Arterial Ischemic Stroke ◽  
Neurological Presentation ◽  
Cardiac Disorders ◽  
Tumor In Childhood

Abstract Background Cardiac disorders are the second leading cause of pediatric arterial ischemic stroke (AIS). Limited literature is available on pediatric AIS caused by cardiac myxoma, a rare tumor in childhood. Methods We describe a new case of pediatric AIS due to a previously unknown atrial myxoma and we conduct a literature review on children with AIS due to cardiac myxoma. Results We identified 41 published pediatric cases of AIS and cardiac myxoma, including ours (56% males, median age at AIS was 11 years [range: 3–18]). AIS presentation was most frequently with hemiparesis/hemiplegia (89%). Multiple brain ischemic lesions were detected in 69% of patients, and arteriopathy in 91%. Seven patients underwent mechanical thrombectomy. At AIS presentation, 73% of children had one or more of the following clinical symptoms/signs suggesting a possible underlying cardiac myxoma: Carney's complex, cardiac auscultation abnormalities, extraneurological symptoms/signs, such as skin signs (12, 38, and 65%, respectively). Cardiac myxoma was diagnosed within 72 hours in 68% of cases. Death occurred in 11%, and 40% had persistent neurological deficits. Conclusion Neurological presentation of AIS due to cardiac myxoma is similar to that of AIS with other etiologies, although clues suggesting a possible underlying cardiac myxoma can be detected in most cases. A timely diagnosis of cardiac myxoma in patients with AIS may favor prompt identification of candidates for endovascular therapy. Therefore, we suggest that in otherwise-healthy children presenting with AIS, transthoracic echocardiography should be performed early after stroke presentation.

Symptom patterns in childhood arterial ischemic stroke: Analysis of a population-based study in Germany

2018 ◽  
Vol 230 (06) ◽  
pp. 319-325
Author(s):  
Lucia Gerstl ◽  
Raphael Weinberger ◽  
Rüdiger von Kries ◽  
Florian Heinen ◽  
Andreas Sebastian Schroeder ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Symptoms ◽  
Population Based ◽  
Case Definition ◽  
Childhood Stroke ◽  
Older Children ◽  
Arterial Ischemic Stroke ◽  
Focal Neurological Deficit ◽  
Symptom Patterns ◽  
Specific Symptoms

Hintergrund Die zeitliche Verzögerung zwischen Symptombeginn und Diagnose ist eine Herausforderung in der Behandlung von Kindern mit arteriell ischämischem Schlaganfall. Frühere Studien zur klinischen Präsentation beschäftigten sich v. a. mit kumulativen Symptomen. Zielsetzung Ziel dieser Studie ist es, mögliche Symptommuster aufzuzeigen. Methoden In einer aktiven Beobachtungsstudie zwischen 01/2015 und 12/2016 (ESPED-Studie) wurden Kinder mit Erstdiagnose eines arteriell ischämischen Schlaganfalls eingeschlossen. Isoliert auftretende Erstsymptome wurden verschiedenen Symptomkombinationen gegenübergestellt. Zudem wurde untersucht, inwieweit ein als „akut“ oder „progredient“ klassifiziertes Auftreten der Symptome Rückschlüsse auf die zugrundeliegende Ätiologie erlaubt. Ergebnisse Es wurden 99 Kinder in die Studie eingeschlossen. Unabhängig vom Alter traten überwiegend fokale Symptome auf (86%). Krampfanfälle als Initialsymptom wurden insbesondere bei Säuglingen beschrieben (67%), wohin-gegen diffuse, unspezifische Symptome vor allem bei Vorschulkindern (38%) und älteren Kindern (59%) auftraten. Isoliert traten fokale Symptome bei 37 Kindern auf, 48 Kinder zeigten zusätzlich unspezifische Symptome, darunter auch 9 Kinder mit Krampfanfällen. Isolierte unspezifische Symptome zeigten sich lediglich bei 7 Kindern, 2 Kinder wurden nur mit Krampfanfällen symptomatisch. Die Akuität des Symptombeginns wurde bei 53/78 als „akut“ und bei “25/78 Fällen als „progredient“ klassifiziert, lieferte jedoch keinen Hinweis auf die zugrundeliegende Ätiologie. Schlussfolgerung Jedes neue fokal neurologische Defizit sollte unabhängig vom Auftreten (isoliert oder kombiniert, akut oder progredient) an einen kindlichen Schlaganfall denken lassen. Background Time delay between onset of clinical symptoms and diagnosis is a challenge in childhood arterial ischemic stroke. Most previous studies reported cumulative symptoms. Objective We attempted to identify typical symptom patterns and assessed their emergence in childhood stroke. Methods Prospective active surveillance in ESPED, a hospital based Pediatric Surveillance Unit for rare diseases in Germany, between January 2015 and December 2016. Case definition: first diagnosis of a radiologically confirmed arterial ischemic stroke. Symptom patterns were identified as occurring in isolation or in combination. We distinguished acute vs. progressive onset. We ascertained risk factors to identify the possible etiology. Results 99 children with childhood arterial ischemic stroke were reported. Focal symptoms were the predominant presenting feature (86%), independent of age. Seizures were more often seen in infants < 1 year (67%), whereas diffuse symptoms were more present in pre-school children (38%) and older children (59%). 37 children had focal features alone and 48 additional non-specific features, including 9 with seizures. Isolated non-specific features accounted for 7 cases, and 2 children had (focal) seizures as the only symptom. In 77% of all cases at least one risk factor was identified. The emergence of symptoms was acute in 53/78 cases and progressive in 25/78 cases. The pattern of emergence was unrelated to the underlying etiology. Conclusions Any new focal neurological deficit in isolation, or associated with seizures or further non-specific symptoms should alert to childhood stroke.

scholarly journals Lipoprotein (a) Levels in Childhood Arterial Ischemic Stroke

2009 ◽  
Vol 16 (2) ◽  
pp. 214-217 ◽  
Author(s):  
Serap Teber ◽  
Gülhis Deda ◽  
Nejat Akar ◽  
Kazım Soylu
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Young Patients ◽  
Control Group ◽  
Healthy Children ◽  
Case Control Studies ◽  
Arterial Ischemic Stroke ◽  
Lipoprotein A ◽  
Screening Programs ◽  
Stroke In Young Adults

Lipoprotein (a) is a cholesterol-rich plasma lipoprotein with a lipid composition similar to that of low-density lipoproteins (LDL). Many prospective and case-control studies identified elevated levels of lipoprotein (a) as a risk factor for premature myocardial infarction and stroke. Elevated lipoprotein (a) has been identified as a genetically determined risk factor for stroke in young adults, but only preliminary data are available on its role as a risk factor for ischemic stroke in infants and children. Fifty two children with arterial ischemic stroke and 78 age- and sex-matched healthy children were studied. Data of this study indicate that 26.9% of children with arterial ischemic stroke had high lipoprotein (a) levels in comparison with the age matched healthy control group. Measurement of lipoprotein (a) should be included in screening programs performed in young patients suffering not only from venous thromboembolism but also arterial ischemic stroke, in addition to other thrombophilic factors.

Incidence of Aspirin ’Resistance’ as Determined Using the PFA-100 in Pediatric Patients with Arterial Ischemic Stroke.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1882-1882 ◽  
Author(s):  
Margaret L. Rand ◽  
Sylvain Lanthier ◽  
Trish Domi ◽  
Dewi Clark ◽  
Anthony K.C. Chan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Platelet Function ◽  
Pediatric Patients ◽  
Aspirin Resistance ◽  
Current Treatment ◽  
Test Time ◽  
Healthy Children ◽  
Arterial Ischemic Stroke ◽  
Normal Range ◽  
Maximum Test

Abstract A significant benefit of aspirin (ASA) has been demonstrated in the prevention of arterial thrombotic events in high-risk adult patients. Despite ASA therapy, recurrence of thromboembolic events, or treatment failure, has been reported in 10–20% of patients, and this has been termed ASA ’resistance’. This term has also been applied to the failure of ASA to affect ASA-dependent laboratory tests. As there is little information on ASA ’resistance’ in children, we examined the efficacy of ASA treatment on platelets from pediatric stroke patients using the PFA-100. Pediatric arterial ischemic stroke afflicts 2–3 children per 100,000 per year, and is associated with recurrent arterial ischemic stroke or transient ischemic attack in 20–40% of cases. Current treatment includes ASA prophylaxis (3 – 5 mg/kg/day) to inhibit platelet function and prevent recurrence, but it is not known whether this ASA dosing regimen is adequate to inhibit platelet function. Our study population consisted of 95 consecutive children with an index arterial ischemic stroke at mean age 5.9 ± 4.8 yrs (range: 0.1 – 17.0 yrs) on active ASA therapy (2.9 ± 1.2 mg/kg/day). Citrated blood samples were obtained at mean age 9.8 ± 4.8 yrs (range: 0.9 – 19 yrs), and were used to measure primary, platelet-related hemostasis in the high-shear PFA-100 system; closure times (CTs) were determined with the collagen/epinephrine cartridge that is sensitive to ASA’s inhibition of thromboxane A2 formation via platelet cyclo-oxygenase 1. The mean CT for all 95 patients was 244 ± 68.1 sec, which is greater than 163 sec, the upper limit of the normal range that we have previously determined for healthy children. The majority of patients, 75/95 (79%), had prolonged CTs (172 sec to > 300 sec), indicating inhibition of platelet function by ASA, and they were thus responsive to ASA therapy. 45 of the 75 ASA responders (63%) had CTs > 300 sec, i.e. CTs greater than the maximum test time of 300 sec, demonstrating aperture non-closure. The remaining 20/95 patients (21%) were ASA ’resistant’, as they did not respond to ASA therapy, having CTs (93 – 163 sec) within the normal range. Mean ASA dosage did not differ between ASA responders (2.8 ± 1.2 mg/kg/day) and ASA ’resistant’ patients (3.0 ± 1.4 mg/kg/day). 6 of the ASA ’resistant’ patients had their ASA dosage increased, and on repeat PFA-100 testing, 5/6 showed increased CTs > 163 sec. In conclusion, in children with arterial ischemic stroke, the majority, 79%, demonstrate inhibition of platelet function, as determined using the PFA-100, by ASA therapy at a mean dose of 2.9 mg/kg/day. The reason for the lack of inhibition of platelet function in 21% of pediatric patients, whether increased ASA dosage or alternative anti-platelet agents (e.g. clopidogrel) should be used in ASA ’resistant’ patients, and the relationship between ASA ’resistance’ and recurrence of arterial thrombotic events in children require further studies.

scholarly journals Overview of The Head CT-Scan in Stroke Patients who was Treated at Muhammadiyah Hospital Palembang

2021 ◽  
Vol 2 (1) ◽  
pp. 24
Author(s):  
Pratrisna Yusastra ◽  
Indriyani Indriyani ◽  
Budi Utama
Keyword(s):  
Ischemic Stroke ◽  
Ct Scan ◽  
Hemorrhagic Stroke ◽  
Right Hemisphere ◽  
Clinical Symptoms ◽  
Neurological Deficits ◽  
Thalamic Lesion ◽  
Stroke Patients ◽  
Head Ct ◽  
The Right

Background: Stroke is a collection of symptoms of neurological deficits due to sudden acute disturbance of brain function, both focal and global, caused by blockage or rupture of arteries and veins and proven by imaging and/or reflex pathology. Using CT-Scan, the description of acute phase stroke can be easier and can determine the appropriate treatment criteria for stroke. Purposes: To determine characteristic Head CT-Scan image of stroke patients hospitalized in Muhammadiyah Palembang Hospital. Methods: This study was conducted in a retrospective descriptive manner and obtained a sample of 41 stroke patients according to the inclusion and exclusion criteria using total sampling. Result: In this study, there were 28 patients (68.2%) with ischemic stroke and 13 patients (31.7%) with hemorrhagic stroke. Head CT-Scan image of ischemic stroke shows basal ganglia lesion (28.5%) and the right hemisphere lesions (57.1%) as the most predominant area. Head CT-Scan image of hemorrhagic stroke (58.3%) had intracerebral hemorrhage with the dominant thalamic lesion area (66.6%) and the right hemisphere (58.3%) had the most lesions with 8 patients (66, 6%) had a midline shift. Stroke patients were treated as experienced by the elderly (90.2%) and were dominated by the female sex (63.4%) and are dominated by clinical symptoms of hemiparesis (29.2%). Conclusion: Stroke patients at Muhammadiyah Palembang hospital dominated by ischemic stroke and on head CT Scan image predominantly shows lesions on the right cerebral hemisphere.

Abstract WMP111: Socioeconomic Determinants of Outcome After Childhood Arterial Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lori C Jordan ◽  
Nancy K Hills ◽  
Warren Lo ◽  
Rebecca N Ichord ◽  
Christine K Fox ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Maternal Education ◽  
Recurrent Stroke ◽  
Pediatric Population ◽  
Neurological Deficits ◽  
Pediatric Stroke ◽  
Arterial Ischemic Stroke ◽  
Vascular Effects ◽  
Middle Income ◽  
Poor Outcome

Introduction: Lower socioeconomic status (SES) is associated with poorer outcome after adult stroke. In a large cohort of children with arterial ischemic stroke (AIS), we determined 12-month neurological outcome and tested the hypothesis that SES is a determinant of outcome in children. Methods: From 2009-2014, the Vascular Effects of Infection in Pediatric Stroke (VIPS) study enrolled 355 children with AIS (29 days-18 years) at 37 international centers, including 3 in lower and middle income (LAMI) countries. Outcome was assessed at 12 months via the recurrence and recovery questionnaire (RRQ) parental report of the pediatric stroke outcome measure (PSOM). Poor outcome was defined as a PSOM of ≥1. Results: Of 355 children, outcome was available for 310 (87%) at a median of 12 months (IQR 11-13). Ten children died prior to hospital discharge and 4 by 12 months. Outcomes improved from discharge to 12 months (Figure). Of 23 cases in LAMI countries, 88% had an income <USD$10,000, compared to 11% of 287 cases in non-LAMI countries. Overall, only 39% LAMI cases had a good outcome, versus 61% of non-LAMI cases (p=0.052). There were too few cases to analyze outcome predictors in LAMI countries. However, in non-LAMI countries, income did not independently predict poor outcome (OR 1.7, 95% CI 0.57, 4.8, for income <$10,000 vs. >$100,000). Other markers of SES (maternal education level and rural/suburban/urban residence) also did not predict outcome. Independent predictors of poor outcome included moderate (OR 4.6, 95% CI 2.0, 11) or severe (OR 21, 95% CI 7.1, 60) neurological deficits at discharge (compared to no deficits) and recurrent stroke (OR 3.5, 95% CI 1.5, 8.3). Conclusion: Outcomes after childhood stroke may be worse in LAMI countries, although we were underpowered to study this subgroup. Within non-LAMI countries, SES does not appear to impact outcome in children, unlike reports in adults, perhaps reflecting better access to rehabilitation services in the pediatric population.

Health-Related Quality of Life and Its Relationship to Neurological Outcome in Child Survivors of Stroke

CNS Spectrums ◽  
2004 ◽  
Vol 9 (06) ◽  
pp. 465-475 ◽  
Author(s):  
Sharon Friefeld ◽  
Ophelia Yeboah ◽  
Janalynn E. Jones ◽  
Gabrielle deVeber
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Normative Data ◽  
Self Report ◽  
Neurological Deficits ◽  
Healthy Children ◽  
Child Survivors ◽  
Related Quality ◽  
Health Related

AbstractBackground:Ischemic stroke during infancy and childhood has the potential to result in neurological impairments and affect a child's ability to function at home, school, and play. There are limited data on the effect of ischemic stroke on quality of life (QOL) of child survivors of ischemic stroke.Objective:To examine parent and child perspectives on QOL and examine factors that correlate with reduced QOL for child survivors of stroke.Methods:A prospective single-center cohort design was used. Participants included children 2–18 years of age surviving ischemic stroke. The Pediatric Quality of Life 4.0 Generic Inventory Scale (PedsQL) parent proxy -report (2–18 years of age) and child self-report (5–18 years of age) were completed by participants. Scores were compared with standardized normative data of healthy children and those with chronic medical conditions. Neurological deficits were measured with the Pediatric Stroke Outcome Measure, a standardized evaluation for children. The relationships between stroke type, neurological deficit, and health-related quality of life (HRQOL) were examined.Results:We assessed the QOL in 84 children with arterial ischemic stroke and 16 with cerebral sinovenous thrombosis at a mean age of 8.4 (4.12) years; 4.4 (2.93) years after their stroke. Results showed that both the parent-proxy and child self-report HRQOL scores were significantly reduced (P&lt;.01) compared with normative data of healthy children. Of greatest concern for both parents and children was the effect of stroke on school, followed by its impact on emotional and social functions. In contrast to other studies, scores in physical domain were better than those in the psychosocial domain. Multivariate analysis showed that of neurological deficits after stroke was a significant predictor of poor HRQOL (P&lt;. 05). The children with poor neurological recovery had the lowest mean PedsQL scores and their QOL was significantly poorer compared with normative data of children with chronic health, conditions (ie, diabetes, cancer).Conclusion:The PedsQL appears to be a promising assessment tool of HRQOL for children following stroke. Both parent and child perspectives should be included because of the potential for there to be significant differences in perspectives. Although severity of neurological outcome is a significant predictor of reduced HRQOL, it accounted for a small proportion of variance in QOL scores. Further research is required to delineate other factors that are significant predictors of outcome.

scholarly journals Mechanical thrombectomy in pediatric acute ischemic stroke: Clinical outcomes and literature review

2016 ◽  
Vol 22 (4) ◽  
pp. 426-431 ◽  
Author(s):  
Thomas P Madaelil ◽  
Akash P Kansagra ◽  
DeWitte T Cross ◽  
Christopher J Moran ◽  
Colin P Derdeyn
Keyword(s):  
Ischemic Stroke ◽  
Literature Review ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Preliminary Evidence ◽  
Neurological Deficits ◽  
Effective Treatment Option ◽  
Aggregate Rate ◽  
Favorable Clinical Outcome

There are limited data on outcomes of mechanical thrombectomy for pediatric stroke using modern devices. In this study, we report two cases of pediatric acute ischemic stroke treated with mechanical thrombectomy, both with good angiographic result (TICI 3) and clinical outcome (no neurological deficits at 90 days). In addition, we conducted a literature review of all previously reported cases describing the use of modern thrombectomy devices. Including our two cases, the aggregate rate of partial or complete vessel recanalization was 100% (22/22), and the aggregate rate of favorable clinical outcome was 91% (20/22). This preliminary evidence suggests that mechanical thrombectomy with modern devices may be a safe and effective treatment option in pediatric patients with acute ischemic stroke.

Predictors of Neurological Outcome of Arterial Ischemic Stroke in Children

2020 ◽  
Author(s):  
Tatia Aprasidze ◽  
Nana Tatishvili ◽  
Teona Shatirishvili ◽  
Giorgi Lomidze
Keyword(s):  
Ischemic Stroke ◽  
Predictive Factors ◽  
Neurological Outcome ◽  
Neurological Status ◽  
Neurological Deficits ◽  
Stroke Recurrence ◽  
Arterial Ischemic Stroke ◽  
Mortality And Morbidity ◽  
Multiple Stroke

AbstractStroke is an important cause of mortality and morbidity in children. The aim of the study was to evaluate long-term neurological outcome in children with arterial ischemic stroke (AIS) and explore predictive factors that affect poor outcome. Fifty-six patients aged between 1 month and 17 years who were treated at M. Iashvili Children's Central Hospital, Tbilisi, Georgia, with an onset of stroke from 2007 to 2017 were included. To explore predictive factors of outcome, the following data were collected: demographic characteristics, risk factors, he presenting signs, radiological features, and presence of stroke recurrence. Neurological status at discharge and long-term neurological outcome at least 1 year after stroke was evaluated according to Pediatric Stroke Outcome Measure subscale. The reported outcome after childhood stroke was variable with long-term neurological deficits in one-third of patients (30.4%). The neurological outcome was worse in males, in patients with multiple stroke episodes, and in those with infarctions involving a combination of cortical and subcortical areas. Pediatric AIS carries the risk of long-term morbidity, and neuroimaging has a predictive influence on outcome.

EARLY AGE ARTERIAL ISCHEMIC STROKE ASSOCIATED WITH MINERALIZING LENTICULOSTRIATAL ANGIOPATHY AND MILD TRAUMATIC BRAIN INJURY

2021 ◽  
Vol 100 (1) ◽  
pp. 42-51
Author(s):  
I.B. Komarova ◽  
◽  
V.P. Zykov ◽  
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Ischemic Stroke ◽  
Head Trauma ◽  
Early Age ◽  
Healthy Children ◽  
Arterial Ischemic Stroke ◽  
Lenticulostriate Arteries ◽  
Cerebral Arteriopathy ◽  
Stroke Type

Study aims: 1) to evaluate the significance of mineralizing angiopathy of lenticulostriate arteries (MALA) in the development of arterial ischemic stroke (AIS) in children; 2) to study clinical and neuroimaging signs of AIS that develops after a head injury and does not meet the criteria of known disease types. Material and methods: to achieve the first aim, groups were formed: 1) the main group – patients with AI, n=86, Me 2,9 years; control – healthy children, n=131, Me 3,2 years. In the compared groups, neurosonography (NSG) protocols were studied for MALA. For the second aim, anamnesis and data from a clinical neuroimaging examination of 106 patients with AIS (Me 2,9 years) were analyzed. Stroke type was identified by the Childhood Arterial Ischemic Stroke Standardized Classification and Diagnostic Evaluation (CASCADE). Results: MALA increases the risk of AIS (ОR 16,15 [95% CI 5,43–48,1]). Stroke that does not meet the criteria of 1–5 types according to CASCADE is often associated with MALA. Clinical of AIS in patients with MALA are early age and mild head trauma (F=6,9, R=0,73, p<0,0001); the onset is marked by the absence of fever, vomiting, seizures, Glasgow coma scale 13, improvement in the first week (F=8,49, R=0,546, p<0,0001). Neuroimaging signs are the basal ganglia lacunar infarct and the absence of cerebral arteriopathy according to magnetic resonance angiography (F=52,8, R=0,402, p<0,0001). The percentage of this type stroke in children with AIS is 26,4%. Conclusion: MALA is a risk factor of AIS in children. AIS in infants which is associated with mineralizing angiopathy of lenticulostriate arteries and mild head trauma is an independent type of stroke. For its verification, computed tomography or NSG are needed.

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