Pediatric Ischemic Stroke: An Infrequent Complication of SARS-CoV-2.
Publication/Presentation Date
4-1-2021
Abstract
OBJECTIVE: Severe complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) include arterial ischemic stroke (AIS) in adults and multisystem inflammatory syndrome in children. Whether stroke is a frequent complication of pediatric SARS-CoV-2 is unknown. This study aimed to determine the proportion of pediatric SARS-CoV-2 cases with ischemic stroke and the proportion of incident pediatric strokes with SARS-CoV-2 in the first 3 months of the pandemic in an international cohort.
METHODS: We surveyed 61 international sites with pediatric stroke expertise. Survey questions included: numbers of hospitalized pediatric (≤ 18 years) patients with SARS-CoV-2; numbers of incident neonatal and childhood ischemic strokes; frequency of SARS-CoV-2 testing for pediatric patients with stroke; and numbers of stroke cases positive for SARS-CoV-2 from March 1 to May 31, 2020.
RESULTS: Of 42 centers with SARS-CoV-2 hospitalization numbers, 8 of 971 (0.82%) pediatric patients with SARS-CoV-2 had ischemic strokes. Proportions of stroke cases positive for SARS-CoV-2 from March to May 2020 were: 1 of 108 with neonatal AIS (0.9%), 0 of 33 with neonatal cerebral sinovenous thrombosis (CSVT; 0%), 6 of 166 with childhood AIS (3.6%), and 1 of 54 with childhood CSVT (1.9%). However, only 30.5% of neonates and 60% of children with strokes were tested for SARS-CoV-2. Therefore, these proportions represent 2.9, 0, 6.1, and 3.0% of stroke cases tested for SARS-CoV-2. Seven of 8 patients with SARS-CoV-2 had additional established stroke risk factors.
INTERPRETATION: As in adults, pediatric stroke is an infrequent complication of SARS-CoV-2, and SARS-CoV-2 was detected in only 4.6% of pediatric patients with ischemic stroke tested for the virus. However, < 50% of strokes were tested. To understand the role of SARS-CoV-2 in pediatric stroke better, SARS-CoV-2 testing should be considered in pediatric patients with stroke as the pandemic continues. ANN NEUROL 2021;89:657-665.
Volume
89
Issue
4
First Page
657
Last Page
665
ISSN
1531-8249
Published In/Presented At
Beslow, L. A., Linds, A. B., Fox, C. K., Kossorotoff, M., Zuñiga Zambrano, Y. C., Hernández-Chávez, M., Hassanein, S. M. A., Byrne, S., Lim, M., Maduaka, N., Zafeiriou, D., Dowling, M. M., Felling, R. J., Rafay, M. F., Lehman, L. L., Noetzel, M. J., Bernard, T. J., Dlamini, N., & International Pediatric Stroke Study Group (2021). Pediatric Ischemic Stroke: An Infrequent Complication of SARS-CoV-2. Annals of neurology, 89(4), 657–665. https://doi.org/10.1002/ana.25991
Disciplines
Medicine and Health Sciences | Pediatrics
PubMedID
33332607
Department(s)
Department of Pediatrics
Document Type
Article