Clinical and radiological recurrence after childhood arterial ischemic stroke
Clinical and radiological recurrence after childhood arterial ischemic stroke
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DOI：
10.1161/circulationaha.105.583690
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发表时间：
2006-11-14
期刊：
影响因子：
37.8
通讯作者：
Kirkham, Fenella J.
中科院分区：
文献类型：
--
作者：
Ganesan, Vijeya;Prengler, Mara;Kirkham, Fenella J.
背景-关于儿童动脉缺血性卒中(AIS)临床和放射学复发的发生率和危险因素的数据可能为二级预防策略提供参考。方法和结果-回顾(1978-1990)和前瞻性(1990-2000)连续在大奥蒙德街医院就诊的首次AIS患者。患者在临床复发时或如果无症状，至少在AIS后一年进行重复神经成像。COX和Logistic回归分析分别探讨危险因素与临床复发和放射学复发之间的关系。总共确认了212名患者，其中97人之前有过另一项诊断。79名儿童有临床复发(29例中风，46例短暂性脑缺血发作[TIA]，4例死亡，1天至11.5岁，中位267天)；5年后，59%(95%可信区间，51%至67%)无复发。在整个组中，血管造影上的烟雾和低出生体重与临床复发独立相关。遗传性血栓形成与既往健康患者的临床复发有关，与烟雾的存在无关。179例重复神经影像检查的患者中有60例出现放射性再梗塞，其中20例临床症状消失。既往TIA、双侧脑梗塞、既往诊断(特别是免疫缺陷)和白细胞增多与再梗塞独立相关。既往的短暂性脑缺血发作和白细胞增多也与临床上无症状的再梗塞独立相关。临床复发的风险在烟雾病儿童中增加，在以前健康的患者中，在那些遗传性血栓形成的患者中。先前存在的病理，包括免疫缺陷和持续性白细胞增多是放射学复发的危险因素，这暗示了慢性感染的潜在作用。
Background - Data on rates and risk factors for clinical and radiological recurrence of childhood arterial ischemic stroke (AIS) might inform secondary prevention strategies.Methods and Results - Consecutive Great Ormond Street Hospital patients with first AIS were identified retrospectively (1978 - 1990) and prospectively (1990 - 2000). Patients underwent repeat neuroimaging at the time of clinical recurrence or, if asymptomatic, at least 1 year after AIS. Cox and logistic regression analyses were used to explore the relationships between risk factors and clinical and radiological recurrence, respectively. A total of 212 patients were identified, of whom 97 had another prior diagnosis. Seventy-nine children had a clinical recurrence (29 strokes, 46 transient ischemic attacks [TIAs], 4 deaths with reinfarction 1 day to 11.5 years median 267 days) later); after 5 years, 59% (95% confidence interval, 51% to 67%) were recurrence free. Moyamoya on angiography and low birth weight were independently associated with clinical recurrence in the whole group. Genetic thrombophilia was associated with clinical recurrence in previously healthy patients, independent of the presence of moyamoya. Sixty of 179 patients who had repeat neuroimaging had radiological reinfarction, which was clinically silent in 20. Previous TIA, bilateral infarction, prior diagnosis (specifically immunodeficiency), and leukocytosis were independently associated with reinfarction. Previous TIA and leukocytosis were also independently associated with clinically silent reinfarction.Conclusions - Clinical and radiological recurrence are common after childhood AIS. The risk of clinical recurrence is increased in children with moyamoya and, in previously healthy patients, in those with genetic thrombophilia. Preexisting pathology, including immunodeficiency, and persistent leukocytosis are risk factors for radiological recurrence, which suggests a potential role for chronic infection.