Showing papers by "Lori C. Jordan published in 2009"

The Importance of Cerebral Aneurysms in Childhood Hemorrhagic Stroke. A Population-Based Study

Abstract: Background and Purpose— Prior population-based studies of pediatric hemorrhagic stroke (HS) had too few incident cases to assess predictors of cerebral aneurysms, a HS etiology that requires urgent intervention. Methods— We performed a retrospective cohort study of HS (intracerebral, subarachnoid [SAH], and intraventricular hemorrhage) using the population of all children <20 years of age enrolled in a large Northern Californian healthcare plan (January 1993 to December 2003). Cases were identified through electronic searches and confirmed through independent chart review by 2 neurologists with adjudication by a third; traumatic hemorrhages were excluded. Logistic regression was used to examine potential predictors of underlying aneurysm. Results— Within a cohort of 2.3 million children followed for a mean of 3.5 years, we identified 116 cases of spontaneous HS (overall incidence, 1.4 per 100000 person-years). Cerebral aneurysms were identified in 15 (13%) of HS cases. Among 21 children with pure SAH, 57%...

The excess burden of stroke in hospitalized adults with sickle cell disease.

Abstract: This report compares the relative rates and risk factors associated with stroke in adults versus children with sickle cell disease (SCD) in the United States over the last decade. We identified incident strokes in patients with SCD using ICD-9 codes for acute stroke and SCD and the California Patient Discharge Databases. We estimated SCD prevalence by using the incidence of SCD at birth with adjustment for early mortality from SCD. We identified 255 acute strokes (70 primary hemorrhagic and 185 ischemic) among 69,586 hospitalizations for SCD-related complications from 1998 to 2007. The rate of stroke in children [ or =65 years old (4,700/100,000 person-years)]. Stroke was associated with hypertension in children and hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation, and renal disease in adults. Most acute strokes (75%) and in-hospital deaths from stroke (91%) occurred in adults. Our results suggest that the rate of stroke in SCD peaks in older adults and is three-fold higher than rates previously reported in African-Americans of similar age (35-64 years) without SCD. Stroke in SCD is associated with several known adult risk factors for ischemic and hemorrhagic stroke. Studies for the primary and secondary prevention of stroke in adults with SCD are urgently needed.

Intracerebral Hemorrhage Volume Predicts Poor Neurologic Outcome in Children

Abstract: Background and Purpose— Although intracerebral hemorrhage (ICH) volume and location are important predictors of outcome in adults, few data exist in children. Methods— A consecutive cohort of children, including full-term newborns to those younger than 18 years of age with nontraumatic, acute ICH and head CT available for analysis were studied. Clinical information was abstracted via chart review. Hemorrhage volume was expressed as percentage of total brain volume (TBV) with large hemorrhage defined as ≥4% of TBV. Hemorrhages were manually traced on each head CT slice and volumes were calculated by multiplying by slice thickness. Location was classified as supratentorial or infratentorial. Logistic regression was used to identify predictors of poor neurological outcome, defined as a Glasgow outcome scale ≤2 (death or persistent vegetative state). Results— Thirty children were included, median age 6 years. Median ICH volume was 20.4 cm3 and median ICH size as a percentage of TBV was 1.9%. Only 4 of 22 chil...

Magnetic resonance imaging and diffusion-weighted imaging of normal-appearing white matter in children and young adults with tuberous sclerosis complex.

Abstract: Introduction Patients with tuberous sclerosis complex (TSC) frequently present with neurocognitive deficits which may be related to impaired white matter maturation. The purposes of our study were (a) to evaluate the white matter maturation in children and young adults with TSC by comparing the apparent diffusion coefficient (ADC) values of normal-appearing white matter (NAWM) with age-matched healthy controls and (b) to determine the association of NAWM-ADC values with the severity of neurological symptoms in TSC patients. Methods Twenty-three TSC patients who underwent magnetic resonance imaging/diffusion-weighted imaging between January 2000 and January 2009 were studied. ADC values of NAWM were measured in the frontal, parietal, occipital lobes, and in the pons. ADC data were compared with age-matched normative data derived from healthy controls. Patients were neurologically scored by a pediatric neurologist. Two-sample t tests and linear regression were conducted using STATA software. Results ADC values of NAWM were higher in TSC patients compared with healthy controls; the increase, however, only reached statistical significance in the frontal white matter and pons in the age group between 96 and 144 months and in the right parietal and occipital white matter in the age group above 144 months. There was no significant change in neurological severity score per unit increase in ADC measurement. Conclusion ADC values of NAWM appear increased in TSC patients. The abnormal ADC values suggest that myelination may be delayed/impaired in TSC patients, which could explain global neurocognitive deficits. Larger prospective studies, including diffusion tensor imaging, are necessary to validate our results.

Early-onset stroke and cerebrovascular disease in adult survivors of childhood cancer

Abstract: Survival rates of childhood cancer patients have improved significantly over decades so that the 5-year survival is 80%, with many surviving to adulthood1; however, with increased longevity comes the risk of late complications. It is therefore incumbent on neurologists to be aware of the risks of long-term neurologic morbidity from cancer therapies and recommendations for monitoring. Amazingly, 1 in 640 adults between ages 20 and 39 years is a childhood cancer survivor.2 Cerebrovascular complications are of particular concern, especially in patients treated with radiation therapy (RT) to the head and neck, which increases the risk of occlusive vasculopathy3,4 Other important stroke risk factors, such as hypertension, central obesity, insulin resistance, and hyperlipidemia, are more common in survivors than in healthy controls5 and may act synergistically with radiation changes to promote cerebrovascular disease. Two large studies in children after cranial RT for acute lymphoblastic leukemia6 and brain tumors7 suggest that radiation dose,6,7 younger age at the time of treatment,7 and the presence of neurofibromatosis type I7 increase the risk of developing …

Stroke: thrombolysis in childhood arterial ischemic stroke.

Abstract: Thrombolytic therapy is often used to treat arterial ischemic stroke in children, despite lack of FDA approval in this age group. The International Pediatric Stroke Study investigators have assessed the extent and nature of recombinant tissue plasminogen activator use in children in their registry, and have compared their findings with previously published case reports.

Regression of cerebral calcifications after endovascular treatment in a case of vein of Galen arteriovenous malformation.

Abstract: The authors present the case of an infant harboring a vein of Galen arteriovenous malformation with conspicuous cerebral calcifications that progressively regressed after staged endovascular obliteration of the lesion. The role of venous hypertension and hydrocephalus secondary to the arteriovenous shunt are discussed to explain the formation and regression of the cerebral calcifications.

Will submandibular TCD prevent stroke in children with sickle cell anemia

Abstract: Stroke is a common and morbid complication of sickle cell disease. Approximately 10% of children with sickle cell anemia (HbSS) will have a stroke by 18 years of age.1 These clinically evident strokes are usually large-vessel and often are associated with the development of obstructive vasculopathy and collaterals (moyamoya).2 As in stroke in other children, intellectual development and ability to function in society are often impaired.3,4 The routine implementation of transcranial Doppler ultrasound (TCD) screening has revolutionized the primary prevention of ischemic stroke in children with HbSS. TCD screening identifies children at a greatly increased risk (∼10%/year) of stroke. Stroke risk in these children with time averaged mean maximal velocity ≥200 cm/s in the middle cerebral artery or distal internal carotid artery (ICA), decreased to about 1%/year with monthly transfusions of sickle-negative blood, a 90% relative risk reduction.5 Thus, …