儿童缺血性脑卒中：SARS-CoV-2 的一种不常见并发症。
Pediatric Ischemic Stroke: An Infrequent Complication of SARS-CoV-2.
机构信息
Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Division of Neurology, Department of Paediatrics, and Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada.
出版信息
Ann Neurol. 2021 Apr;89(4):657-665. doi: 10.1002/ana.25991. Epub 2021 Jan 28.
OBJECTIVE
Severe complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) include arterial ischemic stroke (AIS) in adults and multisystem inflammatory syndrome in children. Whether stroke is a frequent complication of pediatric SARS-CoV-2 is unknown. This study aimed to determine the proportion of pediatric SARS-CoV-2 cases with ischemic stroke and the proportion of incident pediatric strokes with SARS-CoV-2 in the first 3 months of the pandemic in an international cohort.
METHODS
We surveyed 61 international sites with pediatric stroke expertise. Survey questions included: numbers of hospitalized pediatric (≤ 18 years) patients with SARS-CoV-2; numbers of incident neonatal and childhood ischemic strokes; frequency of SARS-CoV-2 testing for pediatric patients with stroke; and numbers of stroke cases positive for SARS-CoV-2 from March 1 to May 31, 2020.
RESULTS
Of 42 centers with SARS-CoV-2 hospitalization numbers, 8 of 971 (0.82%) pediatric patients with SARS-CoV-2 had ischemic strokes. Proportions of stroke cases positive for SARS-CoV-2 from March to May 2020 were: 1 of 108 with neonatal AIS (0.9%), 0 of 33 with neonatal cerebral sinovenous thrombosis (CSVT; 0%), 6 of 166 with childhood AIS (3.6%), and 1 of 54 with childhood CSVT (1.9%). However, only 30.5% of neonates and 60% of children with strokes were tested for SARS-CoV-2. Therefore, these proportions represent 2.9, 0, 6.1, and 3.0% of stroke cases tested for SARS-CoV-2. Seven of 8 patients with SARS-CoV-2 had additional established stroke risk factors.
INTERPRETATION
As in adults, pediatric stroke is an infrequent complication of SARS-CoV-2, and SARS-CoV-2 was detected in only 4.6% of pediatric patients with ischemic stroke tested for the virus. However, < 50% of strokes were tested. To understand the role of SARS-CoV-2 in pediatric stroke better, SARS-CoV-2 testing should be considered in pediatric patients with stroke as the pandemic continues. ANN NEUROL 2021;89:657-665.
目的
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的严重并发症包括成人的动脉缺血性脑卒中（AIS）和儿童的多系统炎症综合征。尚不清楚脑卒中是否为 SARS-CoV-2 感染儿童的常见并发症。本研究旨在确定国际队列中 SARS-CoV-2 感染患儿中缺血性脑卒中的比例，以及大流行前 3 个月内儿童脑卒中事件中 SARS-CoV-2 的比例。
方法
我们调查了 61 个具有儿科脑卒中专业知识的国际站点。调查问题包括：患有 SARS-CoV-2 的住院儿科（≤18 岁）患者人数；新发新生儿和儿童缺血性脑卒中人数；对患有脑卒中的儿科患者进行 SARS-CoV-2 检测的频率；以及 2020 年 3 月 1 日至 5 月 31 日期间 SARS-CoV-2 检测阳性的脑卒中病例数。
结果
在提供 SARS-CoV-2 住院患者数量的 42 个中心中，971 例 SARS-CoV-2 患儿中有 8 例（0.82%）患有缺血性脑卒中。2020 年 3 月至 5 月 SARS-CoV-2 检测阳性的脑卒中病例比例为：108 例新生儿 AIS 中有 1 例（0.9%），33 例新生儿脑静脉窦血栓形成（CSVT）中有 0 例（0%），166 例儿童 AIS 中有 6 例（3.6%），54 例儿童 CSVT 中有 1 例（1.9%）。然而，只有 30.5%的新生儿和 60%的脑卒中患儿接受了 SARS-CoV-2 检测。因此，这些比例代表 SARS-CoV-2 检测的脑卒中病例的 2.9%、0%、6.1%和 3.0%。8 例 SARS-CoV-2 感染患儿中有 7 例存在其他已确立的脑卒中危险因素。
结论
与成人一样，儿科脑卒中是 SARS-CoV-2 的一种罕见并发症，在接受 SARS-CoV-2 病毒检测的缺血性脑卒中患儿中，仅检测到 4.6%的患儿 SARS-CoV-2 呈阳性。然而，<50%的脑卒中患儿接受了检测。为了更好地了解 SARS-CoV-2 在儿科脑卒中中的作用，随着大流行的继续，应考虑对患有脑卒中的儿科患者进行 SARS-CoV-2 检测。神经病学年鉴 2021；89：657-665。
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