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Lookup NU author(s): Dr Rob ForsythORCiD
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© 2014 American Heart Association, Inc. Background and Purpose - Although arteriopathies are the most common cause of childhood arterial ischemic stroke, and the strongest predictor of recurrent stroke, they are difficult to diagnose. We studied the role of clinical data and follow-up imaging in diagnosing cerebral and cervical arteriopathy in children with arterial ischemic stroke. Methods - Vascular effects of infection in pediatric stroke, an international prospective study, enrolled 355 cases of arterial ischemic stroke (age, 29 days to 18 years) at 39 centers. A neuroradiologist and stroke neurologist independently reviewed vascular imaging of the brain (mandatory for inclusion) and neck to establish a diagnosis of arteriopathy (definite, possible, or absent) in 3 steps: (1) baseline imaging alone; (2) plus clinical data; (3) plus follow-up imaging. A 4-person committee, including a second neuroradiologist and stroke neurologist, adjudicated disagreements. Using the final diagnosis as the gold standard, we calculated the sensitivity and specificity of each step. Results - Cases were aged median 7.6 years (interquartile range, 2.8-14 years); 56% boys. The majority (52%) was previously healthy; 41% had follow-up vascular imaging. Only 56 (16%) required adjudication. The gold standard diagnosis was definite arteriopathy in 127 (36%), possible in 34 (9.6%), and absent in 194 (55%). Sensitivity was 79% at step 1, 90% at step 2, and 94% at step 3; specificity was high throughout (99%, 100%, and 100%), as was agreement between reviewers (=0.77, 0.81, and 0.78). Conclusions - Clinical data and follow-up imaging help, yet uncertainty in the diagnosis of childhood arteriopathy remains. This presents a challenge to better understanding the mechanisms underlying these arteriopathies and designing strategies for prevention of childhood arterial ischemic stroke.
Author(s): Wintermark M, Hills NK, de Veber GA, Barkovich AJ, Elkind MSV, Sear K, Zhu G, Leiva-Salinas C, Hou Q, Dowling MM, Bernard TJ, Friedman NR, Ichord RN, Fullerton HJ, Benedict SL, Fox CK, Lo WD, Tan MA, Mackay MT, Kirton A, Hernandez Chavez MI, Humphreys P, Jordan LC, Sultan SM, Rivkin MJ, Rafay MF, Titomanlio L, Kovacevic GS, Yager JY, Amlie-Lefond C, Dlamini N, Condie J, Yeh A, Kneen R, Bjornson BH, Pergami P, Zou LP, Elbers J, Abdalla A, Chan AK, Farooq O, Lim MJ, Carpenter JL, Pavlakis S, Wong VC, Forsyth R
Publication type: Article
Publication status: Published
Journal: Stroke
Year: 2014
Volume: 45
Issue: 12
Pages: 3597-3605
Print publication date: 01/12/2014
Online publication date: 11/11/2014
Acceptance date: 09/10/2014
ISSN (print): 0039-2499
ISSN (electronic): 1524-4628
Publisher: Lippincott Williams and Wilkins
URL: https://doi.org/10.1161/STROKEAHA.114.007404
DOI: 10.1161/STROKEAHA.114.007404
PubMed id: 25388419
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