Ischemic stroke in children and young adults: Etiology and clinical features
- Sabrina E Smith, MD, PhD
Sabrina E Smith, MD, PhD
- Pediatric Neurologist
- Kaiser Permanente Oakland Medical Center
- Christine Fox, MD, MAS
Christine Fox, MD, MAS
- Assistant Professor of Neurology
- University of California, San Francisco
- Section Editors
- Scott E Kasner, MD
Scott E Kasner, MD
- Section Editor — Stroke
- Professor of Neurology
- University of Pennsylvania School of Medicine
- Douglas R Nordli, Jr, MD
Douglas R Nordli, Jr, MD
- Section Editor — Pediatric Neurology
- Chief of Neurology
- Children’s Hospital Los Angeles
- Vice Chair of Neurology
- USC Keck School of Medicine
Although more common in older adults, stroke also occurs in neonates, infants, children, and young adults, resulting in significant morbidity and mortality.
An overview of the epidemiology, risk factors, etiology, clinical presentation, and differential diagnosis of arterial ischemic stroke (AIS) in children one month of age or older and adults younger than 50 years of age is provided here. Other aspects of ischemic stroke in children and young adults are reviewed elsewhere. (See "Ischemic stroke in children: Evaluation, initial management, and prognosis" and "Ischemic stroke in children: Secondary prevention" and "Stroke in the newborn" and "Etiology, clinical features, and diagnosis of cerebral venous thrombosis".)
Annual incidence rates of arterial ischemic stroke (AIS) in infants and children range from 0.6 to 7.9/100,000 children per year [1-3]. In adults younger than 45 years old, incidence ranges from 3.4 to 11.3/100,000 people per year in primarily white populations [4,5], while the incidence in young black adults is as high as 22.8/100,000 people per year .
Several studies have found that pediatric ischemic stroke is more common in boys than in girls [7-9]. As an example, among 1187 children in a multinational pediatric registry of arterial ischemic stroke and cerebral sinovenous thrombosis cases, boys made up 710 of 1187 cases (60 percent) . Male predominance was present regardless of age, stroke subtype, or a history of trauma. The explanation for the apparent male predominance is unknown.
The etiologies and risk factors for arterial ischemic stroke (AIS) in children and young adults differ from those typical in older adults:
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- Etiologies and risk factors in children
- Etiologies and risk factors in young adults
- - Focal cerebral arteriopathy
- - Moyamoya
- - Dissection
- - Vasculitis
- - Others
- Metabolic disorders
- - MELAS and disorders causing metabolic stroke
- Substance abuse
- CLINICAL PRESENTATION
- DIFFERENTIAL DIAGNOSIS