Clinical and Imaging Characteristics of Arteriopathy Subtypes in Children with Arterial Ischemic Stroke: Results of the VIPS Study
Clinical and Imaging Characteristics of Arteriopathy Subtypes in Children with Arterial Ischemic Stroke: Results of the VIPS Study
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DOI：
10.3174/ajnr.a5376
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发表时间：
2017-11-01
影响因子：
3.5
通讯作者：
Fullerton, H. J.
中科院分区：
文献类型：
--
作者：
Wintermark, M.;Hills, N. K.;Fullerton, H. J.
背景和目的：儿童动脉病是罕见的，但异质性，难以诊断和分类，特别是由非专家。我们量化了与儿童动脉病亚型相关的临床和影像学特征，以促进其在研究和临床环境中的诊断和分类。材料和方法：儿科卒中感染的血管效应（VIPS）研究前瞻性纳入了355例动脉缺血性卒中儿童（2010 - 2014）。一个中央专家小组审查了所有数据，以诊断儿童动脉病并对亚型进行分类，包括动脉夹层和局灶性脑动脉病-炎症型，其中包括短暂性脑动脉病、烟雾病和弥漫性/多灶性血管炎。这些分析仅包括卒中病因可以被最终诊断的儿童。我们构建了Logistic回归模型，以确定与每个动脉病亚型的特点。结果：在127名儿童明确动脉病，动脉病亚型不能被分类在18（14%）。烟雾病（n = 34）主要发生在8岁以下的儿童中;局灶性脑动脉病-炎症型（n = 25）发生在8-15岁的儿童中;夹层（n = 26）发生在所有年龄段。脑卒中时出现眩晕在夹层中常见。夹层影响颈动脉，而烟雾病涉及床突上颈内动脉。大脑中动脉M1段的带状外观是局灶性脑动脉病-炎症型的特征，但也存在于
BACKGROUND AND PURPOSE: Childhood arteriopathies are rare but heterogenous, and difficult to diagnose and classify, especially by nonexperts. Wequantified clinical and imaging characteristics associated with childhood arteriopathy subtypes to facilitate their diagnosis and classification in research and clinical settings.MATERIALS AND METHODS: The Vascular Effects of Infection in Pediatric Stroke (VIPS) study prospectively enrolled 355 children with arterial ischemic stroke (2010 -2014). A central team of experts reviewed all data to diagnose childhood arteriopathy and classify subtypes, including arterial dissection and focal cerebral arteriopathy-inflammatory type, which includes transient cerebral arteriopathy, Moyamoya disease, and diffuse/multifocal vasculitis. Only children whose stroke etiology could be conclusively diagnosed were included in these analyses. We constructed logistic regression models to identify characteristics associated with each arteriopathy subtype.RESULTS: Among 127 children with definite arteriopathy, the arteriopathy subtype could not be classified in 18 (14%). Moyamoya disease (n = 34) occurred mostly in children younger than 8 years of age; focal cerebral arteriopathy-inflammatory type (n = 25), in children 8-15 years of age; and dissection (n = 26), at all ages. Vertigo at stroke presentation was common in dissection. Dissection affected the cervical arteries, while Moyamoya disease involved the supraclinoid internal carotid arteries. A banded appearance of the M1 segment of the middle cerebral artery was pathognomonic of focal cerebral arteriopathy-inflammatory type but was present in