Introduction: Perinatal stroke, including neonatal and presumed perinatal presentation, is the most common type of pediatric stroke. No guidelines exist for evaluation after perinatal stroke and the roles of thrombophilia, arteriopathy and cardiac anomalies are unclear. We took a systematic approach to perinatal stroke evaluation to better understand these risk factors.
Hypothesis: Thrombophilia, arteriopathy and cardiac anomalies are more common in perinatal stroke and may predict recurrence.
Methods: After IRB-approval, we reviewed records of perinatal stroke patients from August 2008 to July 2015. Demographics, echocardiography, MRA and thrombophilia testing were collected. Statistical analysis is descriptive.
Results: Among 213 children with perinatal stroke, 92 (43.2%) were female and mean age at diagnosis was 1.56 years. Caucasians comprised 69.5%, African-Americans, 7.5%, Asians, 1.9%, other, 8% and undeclared, 13.1%. Presentation was neonatal (113, 53.1%) or presumed perinatal (100, 46.9%). Strokes were classified as arterial (140, 65.7%), venous (51, 23.9%), both (4, 1.9%) or uncertain (19, 8.5%) by imaging. Mean length of follow-up was 3.2 years. Of 213 patients, 10 (4.7%) experienced recurrent events (4 transient ischemic attack, 3 sinovenous thrombosis and 3 arterial ischemic stroke). Thrombophilia data are presented in Table 1. After excluding venous events, 162 patients were evaluated for arteriopathy, cardiac risk factors and recurrence. Of eight recurrences in this group, none had arteriopathy, 3 (37.5%) had patent foramen ovale and none had other cardiac risk factors, compared to 5/108 (4.6%), 52/102 (51%) and 7/102 (6.8%) in the non-recurrent cases.
Conclusions: Arteriopathy and cardiac anomalies were not associated with recurrence. Some thrombophilia tests appear enriched in perinatal stroke. With few cases of recurrence after perinatal stroke, it is unclear whether thrombophilia predicts recurrence.