Hospital for Sick Children and the University of Toronto,
Toronto, Canada.

BACKGROUND
AND PURPOSE: The purpose of this study was to determine whether
infection with varicella is causal for arterial ischemic stroke (AIS) in
children.
METHODS: First, a prospective cohort study was conducted
in young children (aged 6 months to 10 years) with AIS at 2 institutions
(cohort study). The presence of varicella infection <12 months
before AIS was determined and compared with the published frequency of
varicella infection in the healthy pediatric population. The clinical
and radiographic features of AIS were compared between the varicella and
nonvaricella study cohorts. Second, a literature search of
varicella-associated AIS was conducted, and the clinical and
radiographic features were compared with the study nonvaricella cohort.
RESULTS:
In the cohort study, 22 (31%) of 70 consecutive children with AIS had a
varicella infection in the preceding year compared with 9% in the
healthy population. Children in the varicella cohort were more likely to
have basal ganglia infarcts (P<0.001), abnormal cerebral vascular
imaging (P<0.05), and recurrent AIS or transient ischemic attacks
(P<0.05) than those in the nonvaricella cohort. The pooled literature
analysis of 51 cases of varicella-associated AIS showed similar
findings to the varicella cohort.
CONCLUSION: In young children with
AIS, there is a 3-fold increase in preceding varicella infection
compared with published population rates, and varicella-associated AIS
accounts for nearly one third of childhood AIS. Varicella-associated AIS
has characteristic features, including a 2-fold increase in recurrent
AIS and transient ischemic attacks. Varicella is an important risk
factor for childhood AIS.
PMID: 11387484 [PubMed - indexed for MEDLINE]Free Article