Amlie-Lefond Catherine, Bernard Timothy J, Sébire Guillaume, Friedman Neil R, Heyer Geoffrey L, Lerner Norma B, DeVeber Gabrielle, Fullerton Heather J
Department of Neurology, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, USA.
Circulation. 2009 Mar 17;119(10):1417-23. doi: 10.1161/CIRCULATIONAHA.108.806307. Epub 2009 Mar 2.
Cerebral arteriopathies, including an idiopathic focal cerebral arteriopathy of childhood (FCA), are common in children with arterial ischemic stroke and strongly predictive of recurrence. To better understand these lesions, we measured predictors of arteriopathy within a large international series of children with arterial ischemic stroke.
Between January 2003 and July 2007, 30 centers within the International Pediatric Stroke Study enrolled 667 children (age, 29 days to 19 years) with arterial ischemic stroke and abstracted clinical and radiographic data. Cerebral arteriopathy and its subtypes were defined using published definitions; FCA was defined as cerebral arterial stenosis not attributed to specific diagnoses such as moyamoya, arterial dissection, vasculitis, or postvaricella angiopathy. We used multivariate logistic regression techniques to determine predictors of arteriopathy and FCA among those subjects who received vascular imaging. Of 667 subjects, 525 had known vascular imaging results, and 53% of those (n=277) had an arteriopathy. The most common arteriopathies were FCA (n=69, 25%), moyamoya (n=61, 22%), and arterial dissection (n=56, 20%). Predictors of arteriopathy include early school age (5 to 9 years), recent upper respiratory infections, and sickle cell disease, whereas prior cardiac disease and sepsis reduced the risk of arteriopathy. The only predictor of FCA was recent upper respiratory infection.
Arteriopathy is prevalent among children with arterial ischemic stroke, particularly those presenting in early school age, and those with a history of sickle cell disease. Recent upper respiratory infection predicted cerebral arteriopathy and FCA in particular, suggesting a possible role for infection in the pathogenesis of these lesions.
脑动脉病变，包括儿童特发性局灶性脑动脉病变（FCA），在动脉缺血性卒中患儿中很常见，并且是复发的强烈预测因素。为了更好地了解这些病变，我们在一个大型国际动脉缺血性卒中患儿系列中测量了动脉病变的预测因素。
2003年1月至2007年7月期间，国际儿童卒中研究中的30个中心纳入了667例（年龄29天至19岁）动脉缺血性卒中患儿，并提取了临床和影像学数据。脑动脉病变及其亚型根据已发表的定义进行定义；FCA被定义为脑动脉狭窄，不归因于诸如烟雾病、动脉夹层、血管炎或水痘后血管病变等特定诊断。我们使用多变量逻辑回归技术来确定接受血管成像的受试者中动脉病变和FCA的预测因素。在667例受试者中，525例有已知的血管成像结果，其中53%（n = 277）有动脉病变。最常见的动脉病变是FCA（n = 69，25%）、烟雾病（n = 61，22%）和动脉夹层（n = 56，20%）。动脉病变的预测因素包括入学早期（5至9岁）、近期上呼吸道感染和镰状细胞病，而既往心脏病和败血症降低了动脉病变的风险。FCA的唯一预测因素是近期上呼吸道感染。
动脉病变在动脉缺血性卒中患儿中很普遍，特别是那些入学早期发病的患儿以及有镰状细胞病病史的患儿。近期上呼吸道感染尤其能预测脑动脉病变和FCA，提示感染在这些病变的发病机制中可能起作用。
