Strokes in children linked to infections, inadequate vaccinations

September 30, 2015

MAYWOOD, Ill. - Children who have suffered recent infections or have not received most or all of their vaccinations are at a higher risk for stroke, according to research published in the Sept. 30 issue of Neurology®, the medical journal of the American Academy of Neurology.

The findings conceivably will be "seminal in drafting further stroke prevention strategies" in children, according to an accompanying editorial by senior author Jose Biller, MD, of Loyola University Medical Center and Loyola University Chicago Stritch School of Medicine. Co-author of the editorial is Geoffrey L. Heyer, MD of Nationwide Children's Hospital and Ohio State University.

The editorial by Drs. Biller and Heyer, who were not involved in the study, is titled "A call for new attitudes on infection, vaccination and childhood stroke."

There are between 2.6 and 13 strokes per 100,000 children per year. Developmental, genetic and environmental factors are major contributors to pediatric strokes. Infections also may temporarily increase the risk of stroke. Such infections include flu, upper respiratory tract infections, bacterial and viral infections and, to a lesser extent, urinary tract infections and gastrointestinal infections, according to the editorial.

In the accompanying study in Neurology, Heather J. Fullerton, MD of the University of California at San Francisco and colleagues report latest results from the Vascular Effects of Infection in Pediatric Stroke (VIPS) study. Researchers in the multicenter, case-control study enrolled 355 children between the ages of 29 days and 18 years who had suffered ischemic strokes. (Ischemic strokes are caused by blood clots that block blood flow in the brain.)

Eighteen percent of these children had experienced infections during the week prior to their strokes. By comparison, only 3 percent of children in the control group had suffered infections during the week prior to being interviewed. Children who suffered strokes also were less likely to have received all or most of the recommended vaccinations. Commenting on the study, Drs. Biller and Heyer note that minor infections are common in children. "While further study is needed to clarify how infection increases stroke risk, one can speculate that the physiologic

changes related to infection (systemic inflammation, dehydration and activation of the coagulation system) could tip the balance in a child who is already at risk for stroke," Drs. Biller and Heyer write.

Dr. Biller is an internationally known expert on strokes in children and young adults. He has written a textbook on the topic and is a co-author of the American Heart Association's guidelines for management of stroke in infants and children.

Dr. Biller is chair of the Department of Neurology of Loyola University Chicago Stritch School of Medicine.

Loyola University Health System

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