Lack of Recurrence and
Progressive Arteriopathy among
Children with Cryptogenic Stroke
Dr S. DARTEYRE, MD, MSc1
Dr S. CHABRIER, MD, MSc1
Pr. F. RIVIER, MD, PhD2
1. CHU Saint Etienne. 2. CHU Montpellier
Research Group on Thrombosis, EA 3065
National Centre for Pediatric Stroke
Lecture Plan
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Classification of Stroke in Young Adults.
Classical Clinical Histories in Children.
Study Hypothesis.
Study Methods.
Study Results.
Discussion.
Conclusion.
A Classical Dichotomy
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Adult Stroke Background.
Stroke in Young Adults (< 40 y).
Symptomatic Forms (dissections…).
Cryptogenic Forms (at least 40%).
Connecting Departments.
And Classical Histories…
Lea, 5 years old. Right hemiparesis.
Lateral Lenticulo Striate (LLS).M1 stenosis.
Varicella. Aspirin. Good Recovery.
Study Hypothesis
• Are Childhood Cryptogenic Strokes doing
Better than Symptomatic Ones ?
Study Methods (1)
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Age: 3 months to 16 years.
Arterial Ischemic Strokes (AIS) Bernard Stroke 2012
Transient Ischemic Attacks (TIA) Albers NEJM 2002
Classification of Cerebral Arteriopathies
Bernard Stroke 2012, Sébire Lancet 2006
– Dissections
– Transient Cerebral Arteriopathies (TCA)
– Post-Varicella Arteriopathies (PVA)
– Moya-moya, others…
Study Methods (2)
Symptomatic
Cryptogenic
No Clear Mechanism After
Extensive Work-Up
Clear Mechanism
Risk Factors Only
Altieri Stroke 2009
Study Methods (3)
• Inclusion: age, AIS or TIA.
• Retrospective, single center, ICD-9 and 10.
• Primary Endpoints:
– Recurrences: new AIS/TIA 2 w after index stroke
– Death.
– NIS.
• Secondary Endpoints:
– Radiological Evolution of Arteriopathies.
LONG-TERM NEUROLOGICAL IMPAIRMENT SCORE (NIS)
Education/School
normal = 0
school support = 1
institution = 2
Home support
necessary = 1
not necessary = 0
Language disorders
absent = 0
moderate = 1
severe = 2
Upper extremity motor impairment
absent = 0
light = 1
moderate = 2
severe = 3
Lower extremity motor impairment
absent = 0
light = 1
moderate = 2
severe = 3
Movement disorders
present = 1
absent = 0
Behaviour troubles
present = 1
absent = 0
Epilepsy
absent = 0
benign = 1
severe = 2
TOTAL = / 15
0 - 5: minor impairment
5 - 10: moderate impairment
10 - 15: severe impairment
Results (1)
Results (2)
SYMPTOMATIC ( N=35)
CRYPTOGENIC (N=28)
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Multiple AIS*
Bilateral*
Posterior Infarcts*
Sylvian Superficial*
Vertebral stenosis*
Anticoagulation/Aspirin*
Death = 1
Recurrence 30%*
Mean NIS 4.2*
Progressive Arteriopathies*
Single AIS*
Unilateral*
Anterior Infarcts*
Sylvian Deep (LLS)*
M1 focal stenosis*
Aspirin alone*
Death = 0
Recurrence 0%*
Mean NIS 2.4*
Non-Progressive Arteriopathies*
*p < 0.05
* P < 0.05
Discussion
• Childhood Cryptogenic Strokes Do Better Than
Symptomatic Ones
• Recurrences In Literature: 5-7% Idiopathic
Sträter 2002, Fullerton 2007
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Definition (timing) of Recurrences +++
PVA: symptomatic or cryptogenic ?
Follow-Up
Retrospective = Biases
Conclusion
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Childhood Cryptogenic Stroke.
Multiple Risk Factors.
Aspirin.
To be Validated with EBM.
• Evidence – Ethics – Common Sense
Secondary Prevention for AIS
European Survey
stephane.darteyre@chu-stetienne.fr
stefdart@gmail.com