This Article Full Text Full Text (PDF) All Versions of this Article: 34/12/2887    most recent 01.STR.0000103745.03393.39v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kurnik, K. Articles by Nowak-Göttl, U. Search for Related Content PubMed PubMed Citation Articles by Kurnik, K. Articles by Nowak-Göttl, U. Related Collections Stroke in Children and the Young

(Stroke. 2003;34:2887.)
© 2003 American Heart Association, Inc.

Original Contributions

Recurrent Thromboembolism in Infants and Children Suffering From Symptomatic Neonatal Arterial Stroke

A Prospective Follow-Up Study

Karin Kurnik, MD; Andrea Kosch, MD; Ronald Sträter, MD; Rosemarie Schobess, MD; Christine Heller, MD Ulrike Nowak-Göttl, MD for the Childhood Stroke Study Group

From the Department of Paediatrics, University of Munich, Munich (K.K.); Department of Paediatric Hematology/Oncology, University of Münster, Münster (A.K., R.S., U.N.-G.); Department of Paediatrics, University of Halle an der Saale, Halle an der Saale (R.S.); and Department of Paediatrics, University of Frankfurt, Frankfurt (C.H.), Germany.

Correspondence to Ulrike Nowak-Göttl, MD, Department of Paediatric Hematology/Oncology, Westfälische Wilhelms-University, Albert-Schweitzer-Str 33, D-48149 Münster, Germany. E-mail leagottl{at}uni-muenster.de

Background and Purpose— The present study was performed to evaluate the rate of recurrent symptomatic thromboembolism with respect to prothrombotic risk factors and underlying clinical conditions.

Methods— In a series of 215 consecutively enrolled neonates with arterial ischemic stroke (AIS), the factor V G1691A mutation, factor II G20210A variant, methylenetetrahydrofolate reductase (MTHFR) T677T genotype, lipoprotein (Lp) (a), antithrombin, protein C, protein S, and anticardiolipin antibodies (ACA) were investigated. Patient median follow-up was 3.5 years (range, 1 to 8 years).

Results— During follow-up, 7 infants and children (3.3%) showed recurrent symptomatic thromboembolism (AIS, n=4; venous sinus thrombosis, n=2; deep vein thrombosis of the leg, n=1). The factor V mutation, factor II variant, elevated Lp(a) >30 mg/dL, protein C deficiency, and protein S or antithrombin deficiency were associated with first stroke onset. In 5 of 7 cases (71.4%), prothrombotic risk factors [MTHFR T677T, elevated Lp(a), hyperhomocysteinemia, protein C deficiency] were involved at the time of recurrence. Furthermore, a second thromboembolic event was triggered additionally by underlying diseases (71%), eg, cardiac malformation and immobilization, diarrhea, mastoiditis, and moyamoya syndrome.

Conclusions— Data shown here give evidence that symptomatic recurrent thromboembolism is not common in children with neonatal AIS. The risk of a second event, however, is increased when underlying diseases occur and prothrombotic risk factors are involved.

Key Words: infant, newborn • lipoproteins • protein C deficiency • stroke • thromboembolism

This article has been cited by other articles:

				J Pappachan and F J Kirkham Cerebrovascular disease and stroke Arch. Dis. Child., October 1, 2008; 93(10): 890 - 898. [Abstract] [Full Text] [PDF]

				E. S. Roach, M. R. Golomb, R. Adams, J. Biller, S. Daniels, G. deVeber, D. Ferriero, B. V. Jones, F. J. Kirkham, R. M. Scott, et al. Management of Stroke in Infants and Children: A Scientific Statement From a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young Stroke, September 1, 2008; 39(9): 2644 - 2691. [Abstract] [Full Text] [PDF]

				P. Monagle, E. Chalmers, A. Chan, G. deVeber, F. Kirkham, P. Massicotte, and A. D. Michelson Antithrombotic Therapy in Neonates and Children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 887S - 968S. [Abstract] [Full Text] [PDF]

				R. W. Redline, P. Sagar, M. E. King, K. S. Krishnamoorthy, E. F. Grabowski, and D. J. Roberts Case 12-2008 -- A Newborn Infant with Intermittent Apnea and Seizures N. Engl. J. Med., April 17, 2008; 358(16): 1713 - 1723. [Full Text] [PDF]

				K. C. Fitzgerald, L. S. Williams, B. P. Garg, and M. R. Golomb Epilepsy in Children With Delayed Presentation of Perinatal Stroke J Child Neurol, November 1, 2007; 22(11): 1274 - 1280. [Abstract] [PDF]

				T. N.K. Raju, K. B. Nelson, D. Ferriero, J. K. Lynch, and and the NICHD-NINDS Perinatal Stroke Workshop Part Ischemic Perinatal Stroke: Summary of a Workshop Sponsored by the National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke Pediatrics, September 1, 2007; 120(3): 609 - 616. [Abstract] [Full Text] [PDF]

				M. J.N.L. Benders, F. Groenendaal, C. S.P.M. Uiterwaal, P. G.J. Nikkels, H. W. Bruinse, R. A.J. Nievelstein, and L. S. de Vries Maternal and Infant Characteristics Associated With Perinatal Arterial Stroke in the Preterm Infant Stroke, June 1, 2007; 38(6): 1759 - 1765. [Abstract] [Full Text] [PDF]

				H. J. Fullerton, Y. W. Wu, S. Sidney, and S. C. Johnston Risk of Recurrent Childhood Arterial Ischemic Stroke in a Population-Based Cohort: The Importance of Cerebrovascular Imaging Pediatrics, March 1, 2007; 119(3): 495 - 501. [Abstract] [Full Text] [PDF]

				E. A. Vagiakou, K. A. Voudris, Y. Dimitriou, A. Skardoutsou, and S. Mastroyianni Different Additional Risk Factors for Cerebral Infarctions Associated With the Factor V Leiden Mutation in a Family J Child Neurol, October 1, 2006; 21(10): 903 - 907. [Abstract] [PDF]

				K. C. Fitzgerald, L. S. Williams, B. P. Garg, K. S. Carvalho, and M. R. Golomb Cerebral sinovenous thrombosis in the neonate. Arch Neurol, March 1, 2006; 63(3): 405 - 409. [Abstract] [Full Text] [PDF]

				R. Schneppenheim and J. Greiner Thrombosis in Infants and Children Hematology, January 1, 2006; 2006(1): 86 - 96. [Abstract] [Full Text] [PDF]

				S. Kuhle, L. Mitchell, M. Andrew, A. K. Chan, P. Massicotte, M. Adams, and G. deVeber Urgent Clinical Challenges in Children With Ischemic Stroke: Analysis of 1065 Patients From the 1-800-NOCLOTS Pediatric Stroke Telephone Consultation Service Stroke, January 1, 2006; 37(1): 116 - 122. [Abstract] [Full Text] [PDF]

				J. K. Lynch, C. J. Han, L. E. Nee, and K. B. Nelson Prothrombotic Factors in Children With Stroke or Porencephaly Pediatrics, August 1, 2005; 116(2): 447 - 453. [Abstract] [Full Text] [PDF]

				F. M. Cowan, E. Mercuri, M. A. Rutherford, D.M. Ferriero, V. Ramaswamy, S.P. Miller, A.J. Barkovich, and J.C. Partridge Perinatal stroke in term infants with neonatal encephalopathy Neurology, February 8, 2005; 64(3): 579 - 579. [Full Text] [PDF]

				D. M. Ferriero Neonatal Brain Injury N. Engl. J. Med., November 4, 2004; 351(19): 1985 - 1995. [Full Text] [PDF]

				P. Monagle, A. Chan, P. Massicotte, E. Chalmers, and A. D. Michelson Antithrombotic Therapy in Children*: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 645S - 687S. [Abstract] [Full Text] [PDF]

				S. Chabrier and A. Buchmuller Editorial Comment--Specificities of the Neonatal Stroke Stroke, December 1, 2003; 34(12): 2892 - 2893. [Full Text] [PDF]