Abnormalities of cervical arteries in children with arterial ischemic stroke

Objectives:

To describe the frequency of cervical arterial abnormalities in children with acute arterial ischemic stroke (AIS), to examine predictors of this, and to characterize observed abnormalities in terms of specific diagnoses.

Methods:

Review of case notes of children with AIS (2002–2009) and analysis of their neuroimaging for infarct location and presence, location, and nature of arterial disease. Logistic regression analysis was used to examine the relationship between age, infarct distribution, number of risk factors, antecedent trauma, and the presence of cervical arterial disease.

Results:

Sixty children (31 boys, median age 5 years 3 months) were included. Cerebral infarction was in the anterior circulation only in 50 (25 purely subcortical), the posterior circulation only in 9, and both distributions in 1. Cervical arterial abnormalities occurred in 15/60 (25%) and intracranial abnormalities in 26. There was no significant relationship between the presence of an abnormality in the intracranial and cervical magnetic resonance angiogram (Fisher exact test, p = 0.29). Cervical arterial disease was categorized as definite arterial dissection in 2 cases, probable arterial dissection in 7, nonspecific occlusive arteriopathy in 5, and a migrated vaso-occlusive device in 1. In logistic regression analysis, infarction in the distribution of the posterior circulation significantly predicted the presence of a cervical arterial abnormality (p = 0.04); age, number of risk factors, and antecedent trauma were not predictive.

Conclusion:

Cervical arteriopathy is common in children with AIS, especially in posterior circulation infarction. The cervical vasculature should be imaged in all children with AIS.