Alexander E. Merkler, MD

Lehman LL, Watson CG, Kapur K, Danehy AR, and Rivkin MJ. Predictors of Stroke After Transient Ischemic Attack in Children. Stroke. 2015

Pediatric stroke is a leading cause of death and disability in children. In adults, stroke occurs in 10-15% of adults within 3 months of transient ischemic attack (TIA), but little is known about risk of stroke after TIA in children. In this manuscript, Dr. Lehman et al evaluate predictors of stroke after TIA in children.

63 children were identified as having a TIA at Boston Children’s Hospital. TIA was defined using the time-based definition: a focal neurological deficit that resolved within 24 hours. All patients were required to have an MRI within 3 months of TIA. Similar to adults, almost 80% of patients had motor symptoms. Headache accompanied TIA in 54% of children, but only 10% of patients carried a diagnosis of migraine.

After a median follow-up of 4.5 years, 10/63 children (16%) developed MRI evidence of stroke, 4 (6%) of whom had imaging evidence of stroke at the time of TIA, and 8 (13%) of whom developed new imaging evidence of ischemic injury not seen on the MRI done at the time of TIA.

Independent predictors for stroke after TIA included female sex (OR 11.3, 95% CI, 1.3-98.7), cerebral arteriopathy (OR 24.5, 95% CI, 4.0-149.8), and presence of autoimmune disorders (OR 26.5, 95% CI, 3.6-191.6).

Limitations included 1) small number of patients and therefore wide confidence intervals; 2) retrospective design; 3) use of a time-based definition of TIA thereby likely included cerebrovascular mimics such as migraine.

Overall, similar to adults, children with TIA seem to have a significant risk of developing a stroke. Risk factors for stroke after TIA include female sex, cerebral arteriopathy, and presence of an autoimmune disorder. Further research will be necessary to confirm these findings and help prevent the development of stroke in the pediatric population.