Arteriopathy Diagnosis in Childhood Arterial Ischemic Stroke
| Autor: | Warren D. Lo, Susan L. Benedict, Carlos Leiva-Salinas, Nomazulu Dlamini, Abdalla Ali Abdalla, Sally Sultan, Rebecca Ichord, L.P. Zou, Mark T Mackay, Jerome Y. Yager, Neil R. Friedman, J. Condie, Michael J. Rivkin, Katherine Sear, Timothy J. Bernard, Anthony K.C. Chan, Nancy K. Hills, Lori C. Jordan, Guangming Zhu, Gabrielle deVeber, Osman Farooq, Qinghua Hou, Jessica L. Carpenter, Luigi Titomanlio, Paola Pergami, Bruce Bjornson, Max Wintermark, Michael M. Dowling, Virginia Wong, Ming K. Lim, Gordana Kovacevic, R. Kneen, Adam Kirton, Christine K. Fox, Peter Humphreys, A. James Barkovich, Jorina Elbers, Catherine Amlie-Lefond, Rob Forsyth, Mubeen F. Rafay, Mitchell S.V. Elkind, A. Yeh, M. Hernández Chávez, Marilyn Tan, Steven G. Pavlakis, Heather J. Fullerton |
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| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Neuroradiologist Article Internal medicine medicine Humans Pediatric stroke Vascular Diseases Child Prospective cohort study Stroke Advanced and Specialized Nursing medicine.diagnostic_test business.industry Gold standard Infant Newborn Infant Magnetic resonance imaging Arteries medicine.disease Magnetic Resonance Imaging Arterial Ischemic Stroke Surgery El Niño Child Preschool Cardiology Female Neurology (clinical) Cardiology and Cardiovascular Medicine business |
| Zdroj: | Stroke. 45:3597-3605 |
| ISSN: | 1524-4628 0039-2499 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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