Prothrombotic risk factors and vasculopathies in children after stroke – consequences for treatment

Objectives: To detect risk factors in children after stroke for quality assurance and to adapt therapy to the new cognitions.

Methods: In 16 children after stroke we looked for coagulopathies and risk factors of the cardiovascular system (lipid profile, Homocysteine (Hcy)). Vascular studies were done by cerebral magnetic resonance angiography and Doppler ultrasonography/Duplex sonography of the intra- and extracranial vessels supplying the brain.

Results: 16 children, 9 male, with stroke diagnosed by CT/MRI from 1984–2001 were included. 11 had an ischemic, five a hemorrhagic stroke. Median age at onset was six (0.1–14) years, at follow up 14.3 (7–24.1). Preexisting diseases were congenital heart disease in three, Melas syndrome in one patient. At onset of stroke intracerebral malformation was diagnosed in four, a Moya-Moya syndrome in one patient with trisomy 21 and Factor V Leiden-mutation (FVL) in one child. Five patients had occlusion and/or stenosis of cerebral vessels. Three patients had elevated Hcy, nine elevated lipoproteine (a), one child each was heterozygous for FVL- and prothrombin-mutation. Therefore daily aspirin taking was recommended in three patients, one should take folic acid and low-molecular-weight heparin in thrombogenous situations and two patients should take folic acid. Occupational therapy and/or logotherapy was recommended in three patients.

Conclusion: In 9 of 16 patients therapy had to be changed. In children after stroke vascular status and risk factors should be determined to be able to make specific recommendations for treatment and secondary prevention.

Keywords: stroke, children, thrombophilia, lipoproteine (a), prevention;