Pediatric stroke is associated with COVID-19 infections but not multisystem inflammatory syndrome, study finds

Pediatric stroke is associated with COVID-19 infections but not multisystem inflammatory syndrome, study finds
Pediatric stroke is associated with COVID-19 infections but not multisystem inflammatory syndrome, study finds

In a recent study published in Pediatric neurologyresearchers investigated whether coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C) were associated with an increased risk of ischemic stroke in pediatric populations.

Study: SARS-CoV-2 infection and increased risk of pediatric stroke. Image Credit: joel bubble ben / Shutterstock

Background

Mounting evidence suggests that adult patients with COVID-19 are at increased risk of stroke, which is attributed to various factors such as hypercoagulability, immune-mediated thrombosis, changes in the renin system -angiotensin, cardioembolism, and other COVID-19-mediated changes to the heart and nervous systems.

The ability of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to use angiotensin-converting enzyme-2 (ACE-2) receptors to enter host cells is also linked to neurotropism and to the effect of the virus on several organ systems.

However, there is little information on whether children with COVID-19 are at higher risk for stroke. While studies found no increased risk of ischemic stroke in pediatric COVID-19 patients early in the pandemic, neurological complications and some forms of vasculopathy were seen in a quarter of MIS-C patients. Additionally, while thromboembolism and stroke have been considered rare complications of MIS-C, the causal relationships are not well understood.

About the study

In the present study, the researchers conducted retrospective analyzes on two population-based cohorts of children under 18 years of age. The first cohort included children diagnosed with intracranial hemorrhage, cerebral infarction, ischemic stroke or stroke between March 2020 and June 2021. The second included children hospitalized for stroke between March 2015 and February 2020 at the Primary Children’s Hospital in Utah, United States.

Data on demographic characteristics such as gender, age, socioeconomic status, insurance coverage, and race or ethnicity were obtained from electronic records. Additional information such as medical history, COVID-19 polymerase chain reaction (PCR) test results, COVID-19 vaccination data, dates and length of hospital and unit admissions intensive care unit, time from onset of COVID-19 symptoms to stroke, National Institute of Health Stroke Scale (NIHSS) on stroke presentation, stroke characteristics, treatment given and outcome of stroke were assessed.

Results

The results reported 16 cases of pediatric ischemic stroke in patients aged eight months to 17 years. The incidence of ischemic stroke was correlated with an increase in COVID-19 infections in children, but was not associated with an increase in the frequency of MIS-C.

A third of patients who suffered a stroke had already been infected with SARS-CoV-2, had been diagnosed with MIS-C, were unvaccinated or had antibodies against SARS-CoV-2 when they were suffered the stroke. Since other viral infections during the period had declined, COVID-19 is thought to be a stroke trigger. Unlike previous studies that reported an increase in focal cerebral arterial disease associated with COVID-19, the present study found that large vessel occlusive stroke was more prevalent in the pandemic and prepandemic cohorts.

While three of the patients had been diagnosed with MIS-C at the time of the stroke, three other patients with prior mild or asymptomatic SARS-CoV-2 infections and no diagnosed MIS-C patients also underwent of stroke. Only a quarter of patients in the pandemic cohort received tissue plasminogen activator or thrombectomy since stroke diagnosis in most pandemic patients, and the pre-pandemic cohorts were delayed.

Moreover, acute SARS-CoV-2 infections were not found to be associated with stroke, suggesting that stroke may be associated with the hyperinflammatory state observed in COVID-19 patients in two to six weeks after recovery. In addition, the prothrombotic state and hypercoagulability that result from activation of coagulation cascades and endothelial damage due to viral infection have also been implicated in the occurrence of strokes in pediatric patients.

The study suggested that stroke could occur one month after COVID-19 infection, likely due to hypercoagulability and prothrombotic state resulting from weeks following SARS-CoV-2 infections. Additionally, since the incidence of stroke in the pediatric population is rare and the presentation of stroke symptoms in children is vague, it is often misdiagnosed or diagnosed late, delaying intervention. .

conclusion

To summarize, the study investigated the association between stroke, COVID-19 infections and multisystem inflammatory syndrome in children using a retrospective analysis on two cohorts of pediatric stroke patients , one covering the COVID-19 pandemic and the other pre-pandemic.

The results indicated that stroke is a delayed complication of prior SARS-CoV-2 infections, but is not associated with acute infections or MIS-C. In addition, stroke is often diagnosed late in pediatric patients due to vague symptoms, delaying treatments and interventions.

Journal reference:

  • Vielleux, MJ, Swartwood, S., Nguyen, D., James, KE, Barbeau, B., & Bonkowsky, JL (2022). SARS-CoV-2 infection and increased risk of pediatric stroke. Pediatric neurology. do I: https://doi.org/10.1016/j.pediatrneurol.2022.10.003 https://www.sciencedirect.com/science/article/pii/S0887899422002107

. study finds stroke pediatric is associated with infections COVID19 but not inflammatory syndrome multisystemic

. Pediatric stroke COVID19 infections multisystem inflammatory syndrome study finds

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