Arteriopathy diagnosis in childhood arterial ischemic stroke: results of the vascular effects of infection in pediatric stroke study.
Publication/Presentation Date
12-1-2014
Abstract
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 (κ=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.
Volume
45
Issue
12
First Page
3597
Last Page
3605
ISSN
1524-4628
Published In/Presented At
Wintermark, M., Hills, N. K., deVeber, G. A., Barkovich, A. J., Elkind, M. S., Sear, K., Zhu, G., Leiva-Salinas, C., Hou, Q., Dowling, M. M., Bernard, T. J., Friedman, N. R., Ichord, R. N., Fullerton, H. J., & VIPS Investigators (2014). Arteriopathy diagnosis in childhood arterial ischemic stroke: results of the vascular effects of infection in pediatric stroke study. Stroke, 45(12), 3597–3605. https://doi.org/10.1161/STROKEAHA.114.007404
Disciplines
Medicine and Health Sciences | Pediatrics
PubMedID
25388419
Department(s)
Department of Pediatrics
Document Type
Article