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Lack of Recurrence and Progressive Arteriopathy among Children with Cryptogenic Stroke

Lack of Recurrence and Progressive Arteriopathy among Children with Cryptogenic Stroke. Dr S. DARTEYRE, MD, MSc 1 Dr S. CHABRIER, MD, MSc 1 Pr. F. RIVIER, MD, PhD 2 1. CHU Saint Etienne. 2. CHU Montpellier Research Group on Thrombosis , EA 3065 National Centre for Pediatric Stroke.

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Lack of Recurrence and Progressive Arteriopathy among Children with Cryptogenic Stroke

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  1. Lack of Recurrence and Progressive Arteriopathy amongChildrenwithCryptogenic 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

  2. Lecture Plan • Classification of Stroke in Young Adults. • ClassicalClinicalHistories in Children. • StudyHypothesis. • StudyMethods. • StudyResults. • Discussion. • Conclusion.

  3. A ClassicalDichotomy • Adult Stroke Background. • Stroke in Young Adults (< 40 y). • SymptomaticForms (dissections…). • CryptogenicForms (at least 40%). • ConnectingDepartments.

  4. And Classical Histories… Lea, 5 yearsold. Right hemiparesis. LateralLenticuloStriate (LLS).M1 stenosis. Varicella. Aspirin. Good Recovery.

  5. StudyHypothesis • Are ChildhoodCryptogenicStrokesdoingBetterthanSymptomaticOnes ?

  6. StudyMethods (1) • Age: 3 months to 16 years. • ArterialIschemicStrokes(AIS) Bernard Stroke 2012 • TransientIschemicAttacks (TIA) Albers NEJM 2002 • Classification of CerebralArteriopathies Bernard Stroke 2012, Sébire Lancet 2006 • Dissections • TransientCerebralArteriopathies (TCA) • Post-VaricellaArteriopathies (PVA) • Moya-moya, others…

  7. StudyMethods (2) Symptomatic Cryptogenic No ClearMechanismAfter Extensive Work-Up RiskFactorsOnly Altieri Stroke 2009 ClearMechanism

  8. StudyMethods (3) • Inclusion: age, AIS or TIA. • Retrospective, single center, ICD-9 and 10. • PrimaryEndpoints: • Recurrences: new AIS/TIA 2 w after index stroke • Death. • NIS. • SecondaryEndpoints: • Radiological Evolution of Arteriopathies.

  9. LONG-TERM NEUROLOGICAL IMPAIRMENT SCORE (NIS) 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 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 TOTAL = / 15 0 - 5: minor impairment 5 - 10: moderate impairment 10 - 15: severe impairment

  10. Results (1)

  11. Results (2) SYMPTOMATIC ( N=35) CRYPTOGENIC (N=28) Single AIS* Unilateral* AnteriorInfarcts* Sylvian Deep (LLS)* M1 focal stenosis* Aspirinalone* Death = 0 Recurrence0%* MeanNIS2.4* Non-ProgressiveArteriopathies* • Multiple AIS* • Bilateral* • PosteriorInfarcts* • SylvianSuperficial* • Vertebralstenosis* • Anticoagulation/Aspirin* • Death = 1 • Recurrence30%* • MeanNIS4.2* • Progressive Arteriopathies* *p < 0.05

  12. * P < 0.05

  13. Discussion • ChildhoodCryptogenicStrokes Do BetterThanSymptomaticOnes • Recurrences In Literature: 5-7% Idiopathic Sträter 2002, Fullerton 2007 • Definition (timing) of Recurrences +++ • PVA: symptomatic or cryptogenic ? • Follow-Up • Retrospective =Biases

  14. Conclusion • ChildhoodCryptogenicStroke. • Multiple RiskFactors. • Aspirin. • To beValidatedwith EBM. • Evidence – Ethics – Common Sense

  15. SecondaryPrevention for AIS European Survey stephane.darteyre@chu-st-etienne.fr stefdart@gmail.com

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