Paediatric ischemic stroke associated with cardiac disorders Children’s Clinical University Hospital 2018–2022

Background. A cardiogenic stroke is an ischemic stroke caused by embolic material formed in the cavities or valves of the heart and constitutes up to 30% of paediatric arterial ischemic strokes (AIS). The causes and pathomechanisms of cardiogenic stroke in the paediatric population are different from those in adults. In an analysis of children with ischemic stroke (Dowling MM et al., 2012), 30.6% were diagnosed with heart disease. Congenital heart defects were found in 59.3%, acquired cardiovascular abnormalities in 19.6%, and PFO (patent foramen ovale) in 15.2%. All the paediatric patients with congenital and acquired cardiac pathologies and paediatric stroke in Latvia are treated at Children’s Clinical University Hospital
(CCUH).
Aim. To analyse data of all the paediatric patients treated with ischemic stroke associated with cardiac disorders during the years 2018-2022.
Methods. From the CCUH electronic database, all the patients treated with ischemic stroke were selected, and those with association with cardiac disorders were further analysed.
Results. From January 1, 2018, until December 31, 2022: 22 children with acute ischemic stroke were treated in CCUH. 7 patients (3 boys (43%), 4 girls (57%) had clinically detected acute ischemic stroke associated with cardiac disorder: 3 congenital heart diseases (43%), 1 myocarditis (14%), 3 PFO (paradoxical embolization) (43%). 2 patients had prior cardiac surgery (29%) 1-angiography 14%. Age at presentation
with stroke 7.83 ± 5.5 years, manifestation: right-sided hemiparesis 71% (n = 5), left-sided hemiparesis 29% (n = 2), aphasia n = 1 (14%). Only 1 patient had a positive family history (14.3%), 1 patient (14.3%) had genetically proven thrombophilia. 2 patients (28.6%) had a positive ANA. The mean hospitalization time was 30.7 ± 15.5 days. Initial treatment: 6 low molecular weight heparins (86%), 1 aspirin (14%). Further treatment: 4 new anticoagulants (rivaroxaban) (57%), 2-warfarin (29%), 1-aspirin. 3 patients underwent transvasal PFO closure. Patients were followed up for 13.9 ± 6 months, at the end of follow up in 3 patients neurological findings had resolved (43%), but in 4 (57%) hemiparesis remained. At the end of follow up 4 patients received aspirin (57%), 1- warfarin (14%). During the study period, 1 infant boy treated with infectious endocarditis (large mitral valve vegetation, S. aureus) had clinically asymptomatic cerebral micro embolus detected on MRI before cardiac surgery but did not show neurological findings.
Conclusion. Cardiac disorders are connected with approximately one-third of all cases of paediatric ischemic strokes with a need for a long-term follow-up, treatment, rehabilitation and long-term neurological sequel in the majority of patients.
Acknowledgements. No conflicts of interest. No funding.