Arterial Ischemic Stroke: Common Risk Factors in Newborns and Children
Arterial Ischemic Stroke: Common Risk Factors in Newborns and Children
复制标题
动脉缺血性中风：新生儿和儿童的常见危险因素
作者：
S. Pavlakis;K. Levinson
关于儿童和新生儿动脉缺血性卒中（AIS）的危险因素知之甚少。关于儿科AIS的风险因素正在演变，按患病率顺序包括：血管病变、感染、心脏病、镰状细胞病（SCD）和“其他”原因。然而，多达27%的儿童和大多数新生儿中风没有可识别的风险因素。
围产期AIS（定义为分娩前1个月至分娩后1个月发生）的发病率约为每10000名足月婴儿4例。2新生儿卒中的直接原因尚不清楚。母体易感因素可能包括舞蹈病、胎膜早破和首次妊娠。3分娩过程本身可能是一种风险，AIS可能是多基因的。在新生儿缺氧缺血性脑病（HIE）中，10%的重度HIE患儿可出现局灶性梗死。由MRA确定的血栓倾向和血管病变是罕见的。3围产期卒中通常不会复发。
儿童AIS的定义是发生在1个月至18岁之间，高峰在5岁左右。3风险因素包括动脉病、感染、心脏病、血液病和遗传性。这些危险因素中有许多的病理生理学是重叠的。
动脉病变可能是急性的、一过性的或进行性的，约50%的AIS儿童可能发生动脉病变，但不同系列的估计值不同。1最常见的动脉病变是儿童局灶性动脉病变（FAC）、烟雾病和动脉夹层。1 FAC由国际儿科卒中研究组（IPSS）提出。以前的研究表明与感染因子如水痘有关。1，3，4，5此外，动脉病与镰状细胞病（SCD）和先天性血管发育不良异常有关。
Little is known about risk factors in pediatric and newborn arterial ischemic stroke (AIS). Risk factors regarding pediatric AIS are evolving and include, in order of prevalence: vasculopathy, infection, cardiac disease, sickle cell disease (SCD), and “other” causes. However, as many as 27% of pediatric and most newborn strokes have no identifiable risk factor.1
The incidence of perinatal AIS, defined as occurring one month before to one month after delivery, is approximately 4 per 10 000 full-term babies.2 Direct causes for newborn stroke are not well understood. Predisposing maternal factors may include choreoamnionitis, premature rupture of membranes, and first-time pregnancy.3 The birthing process itself may be a risk, and AIS is likely polygenic. In neonates with hypoxic ischemic encephalopathy (HIE), 10% of those with severe HIE may have focal infarcts. Thrombophilias and vasculopathies as determined by MRA are rare.3 Perinatal stroke does not usually recur.
Pediatric AIS is defined as occurring age 1 month through 18 years with a peak at about age 5 years.3 Risk factors include arteriopathies, infection, cardiac disease, blood disorders, and heritability. There is overlapping pathophysiology of many of these risk factors.
Arteriopathies may be acute, transient, or progressive and can occur in about 50% of children with AIS, but estimates vary between series.1 The most common arteriopathies are focal arteriopathy of childhood (FAC), Moyamoya, and arterial dissection.1 FAC is coined by the International Pediatric Stroke Study Group (IPSS). Previous studies show an association with infectious agents such as varicella.1,3,4,5 Additionally, arteriopathies are associated with sickle cell disease (SCD) and congenital hypoplastic vessel abnormalities.3,4,5 Once a …