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(Stroke. 2009;40:52.)
© 2009 American Heart Association, Inc.

Original Contributions

Male Predominance in Childhood Ischemic Stroke

Findings From the International Pediatric Stroke Study

Meredith R. Golomb, MD, MSc; Heather J. Fullerton, MD, MAS; Ulrike Nowak-Gottl, MD; Gabrielle deVeber, MD, MHSc for the International Pediatric Stroke Study Group

From the Department of Neurology (M.R.G.), Division of Pediatric Neurology, Indiana University School of Medicine, Indianapolis, IN; the Departments of Neurology and Pediatrics (H.J.F.), University of California, San Francisco, Calif; Department of Pediatric Hematology/Oncology (U.N.-G.), University Children’s Hospital, University of Münster, Münster, Germany; and the Department of Neurology (G.d.V.), Hospital for Sick Children, Toronto, Ontario, Canada.

Correspondence to Meredith R. Golomb, MD, MSc, Indiana University School of Medicine, Building XE 040, 575 West Drive, Indianapolis, IN 46202. E-mail mgolomb{at}iupui.edu

Background and Purpose— Previous studies suggested a male predominance in childhood ischemic stroke, mirroring gender differences in adults but were limited by small sample sizes or unconfirmed diagnoses. We sought to study gender within a large international series of confirmed cases of pediatric ischemic stroke.

Methods— From January 2003 to July 2007, the International Pediatric Stroke Study enrolled children (0 up to 19 years) with arterial ischemic stroke or cerebral sinovenous thrombosis at 30 centers in 10 countries. Neonates were those <29 days of age. We calculated the "expected" gender ratio for our study as the weighted average of population-based childhood gender ratios in enrolling countries weighted by the number of subjects enrolled in each country. ² tests were used to compare the observed gender ratios in our series with this expected ratio (51.7%).

Results— Among 1187 children with confirmed ischemic stroke, 710 were boys (60%, P<0.0001). Male predominance persisted after stratification by age (61% for neonates, P=0.011; 59% for later childhood, P=0.002) and stroke subtype (58% for arterial ischemic stroke, P=0.004; 65% for cerebral sinovenous thrombosis, P=0.002). The greatest proportion of males occurred among children with arterial ischemic stroke and a history of trauma (75%, P=0.008), although boys were also overrepresented among those with arterial ischemic stroke and no trauma (57%; P=0.07). There were no gender differences in case fatality or deficits at discharge.

Conclusions— Childhood ischemic stroke appears to be more common in boys regardless of age, stroke subtype, or history of trauma. Further exploration of this gender difference could shed light on stroke mechanisms in both children and adults.

Key Words: child • sex distribution • stroke

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