International Prevalence and Mechanisms of SARS-CoV-2 in Childhood Arterial Ischemic Stroke During the COVID-19 Pandemic

被引：16

作者：

Beslow, Lauren A. ^{[1
,2
]}

Agner, Shannon C. ^{[3
]}

Santoro, Jonathan D. ^{[4
]}

Ram, Dipak ^{[5
]}

Wilson, Jenny L. ^{[6
]}

Harrar, Dana ^{[7
]}

Appavu, Brian ^{[8
]}

Fraser, Stuart M. ^{[9
]}

Rossor, Thomas ^{[10
]}

Torres, Marcela D. ^{[11
]}

Kossorotoff, Manoelle ^{[12
]}

Zuniga Zambrano, Yenny C. ^{[13
]}

Hernandez-Chavez, Marta ^{[14
]}

Hassanein, Sahar M. A. ^{[15
]}

Zafeiriou, Dimitrios ^{[16
]}

Dowling, Michael M. ^{[17
]}

Kopyta, Ilona ^{[18
]}

Stence, Nicholas, V ^{[19
]}

Bernard, Timothy J. ^{[20
,21
]}

Dlamini, Nomazulu ^{[22
]}

机构：

[1] Univ Penn, Childrens Hosp Philadelphia, Perelman Sch Med, Div Neurol,Dept Neurol, Philadelphia, PA 19104 USA

[2] Univ Penn, Childrens Hosp Philadelphia, Perelman Sch Med, Div Neurol,Dept Pediat, Philadelphia, PA 19104 USA

[3] Washington Univ, St Louis Childrens Hosp, Sch Med, Div Pediat & Dev Neurol, St Louis, MO 63110 USA

[4] USC, Childrens Hosp Los Angeles, Keck Sch Med, Div Neurol,Dept Neurol, Los Angeles, CA USA

[5] Royal Manchester Childrens Hosp, Dept Paediat Neurol, Manchester, Lancs, England

[6] Oregon Hlth & Sci Univ, Dept Pediat, Div Pediat Neurol, 3181 Sw Sam Jackson Pk Rd, Portland, OR 97201 USA

[7] Childrens Natl Med Ctr, Div Neurol, Washington, DC 20010 USA

[8] Univ Arizona, Coll Med, Phoenix Childrens Hosp, Div Neurol, Phoenix, AZ USA

[9] Childrens Mem Hermann Hosp, Div Neurol, Houston, TX USA

[10] Evelina London Childrens Hosp, London, England

[11] Cook Childrens Med Ctr, Div Hematol, Ft Worth, TX USA

[12] Univ Hosp Necker Enfants Malad, AP HP, French Ctr Pediat Stroke, Pediat Neurol Dept, Paris, France

[13] HOMI Fdn Hosp Pediat Misericordia, Unit Pediat Neurol, Bogota, Colombia

[14] Pontificia Univ Catolica Chile, Sch Med, Div Pediat, Unit Pediat Neurol, Santiago, Chile

[15] Ain Shams Univ, Fac Med, Dept Pediat, Cairo, Egypt

[16] Aristotle Univ Thessaloniki, Hippokratio Gen Hosp, Dept Pediat, Thessaloniki, Greece

[17] Univ Texas Southwestern Med Ctr Dallas, Dept Pediat, Dallas, TX USA

[18] Med Univ Silesia, Dept Child Neurol, Katowice, Poland

[19] Univ Colorado, Childrens Hosp Colorado, Sch Med, Dept Radiol,Sect Pediat Radiol, Aurora, CO USA

[20] Univ Colorado, Sch Med, Hemophilia & Thrombosis Ctr, Sect Child Neurol,Childrens Hosp Colorado,Dept Pe, Aurora, CO USA

[21] Univ Colorado, Sch Med, Hemophilia & Thrombosis Ctr, Sect Child Neurol,Childrens Hosp Colorado,Dept Ne, Aurora, CO USA

[22] Univ Toronto, Hosp Sick Children, Dept Pediat, Div Neurol,Child Hlth Evaluat Sci Program, Toronto, ON, Canada

来源：

STROKE | 2022年 / 53卷 / 08期

关键词：

arteriopathy; child; hospitalization; ischemic stroke; risk factors; CHILDREN;

D O I：

10.1161/STROKEAHA.121.038250

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: Data from the early pandemic revealed that 0.62% of children hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had an acute arterial ischemic stroke (AIS). In a larger cohort from June 2020 to December 2020, we sought to determine whether our initial point estimate was stable as the pandemic continued and to understand radiographic and laboratory data that may clarify mechanisms of pediatric AIS in the setting of SARS-CoV-2. Methods: We surveyed international sites with pediatric stroke expertise to determine numbers of hospitalized SARS-CoV-2 patients <18 years, numbers of incident AIS cases among children (29 days to <18 years), frequency of SARS-CoV-2 testing for children with AIS, and numbers of childhood AIS cases positive for SARS-CoV-2 June 1 to December 31, 2020. Two stroke neurologists with 1 neuroradiologist determined whether SARS-CoV-2 was the main stroke risk factor, contributory, or incidental. Results: Sixty-one centers from 21 countries provided AIS data. Forty-eight centers (78.7%) provided SARS-CoV-2 hospitalization data. SARS-CoV-2 testing was performed in 335/373 acute AIS cases (89.8%) compared with 99/166 (59.6%) in March to May 2020, P<0.0001. Twenty-three of 335 AIS cases tested (6.9%) were positive for SARS-CoV-2 compared with 6/99 tested (6.1%) in March to May 2020, P=0.78. Of the 22 of 23 AIS cases with SARS-CoV-2 in whom we could collect additional data, SARS-CoV-2 was the main stroke risk factor in 6 (3 with arteritis/vasculitis, 3 with focal cerebral arteriopathy), a contributory factor in 13, and incidental in 3. Elevated inflammatory markers were common, occurring in 17 (77.3%). From centers with SARS-CoV-2 hospitalization data, of 7231 pediatric patients hospitalized with SARS-CoV-2, 23 had AIS (0.32%) compared with 6/971 (0.62%) from March to May 2020, P=0.14. Conclusions: The risk of AIS among children hospitalized with SARS-CoV-2 appeared stable compared with our earlier estimate. Among children in whom SARS-CoV-2 was considered the main stroke risk factor, inflammatory arteriopathies were the stroke mechanism.

引用

页码：2497 / 2503

页数：7

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