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Gabrielle deVeber, MD; Paul Monagle, MBBS; Anthony Chan, MBBS; Daune MacGregor, MD; Rosalind Curtis, MD; Sharon Lee, BSc; Patricia Vegh; Margaret Adams; Velma Marzinotto, BScN; Michael Leaker, MD; M. Patricia Massicotte, MD; David Lillicrap, MD; Maureen Andrew, MD

Arch Neurol. 1998;55:1539-1543.

Background  To our knowledge, the contribution of prothrombotic conditions to cerebral thromboembolism has never been prospectively studied in a large series of pediatric patients.

Methods  The Hospital for Sick Children, Toronto, Ontario, established a program in January 1992 to diagnose and treat children (term newborn to 18 years old) with arterial ischemic stroke or sinovenous thrombosis. The routine evaluation for prothrombotic conditions included plasminogen, antithrombin, protein C, free protein S, activated protein C resistance, IgG and IgM anticardiolipin antibody, and lupus anticoagulant. We analyzed samples taken within 2 years of the event. We report results on patients seen from January 1, 1992, to January 1, 1997.

Results  Ninety-two patients (47 males and 45 females) entered the program during the study interval. Patients ranged from newborn to 18 years in age. Arterial ischemic stroke occurred in 78% of patients while sinovenous thrombosis occurred in 22%. All were tested for prothrombotic disorders. One or more abnormal results were present in 35 (38%) of the 92 patients. The majority (21/35) had multiple abnormal test results. The abnormal test results were anticardiolipin antibody (33%), plasminogen (9.5%), activated protein C resistance (9%), protein C (7%), antithrombin (12.5%), lupus anticoagulant (8%), and free protein S (11.5%). Male sex predicted the presence of prothrombotic abnormalities (relative risk, 1.7; 95% confidence interval, 1.2-2.5), but stroke type (relative risk, 0.8; 95% confidence interval, 0.7-1.1), age group, and presence of other risk factors did not predict abnormal testing.

Conclusions  A significant proportion (38%) of children with cerebral thromboembolism had evidence of prothrombotic conditions. In particular, there was a predominance of children with anticardiolipin antibody (33%). These data support a recommendation that children with cerebral thromboembolism be evaluated for prothrombotic disorders.

From Hamilton Civic Hospitals Research Center (Drs deVeber, Monagle, Chan, and Andrew and Mss Lee, Vegh, and Adams) and the Department of Pediatrics, McMaster University, Hamilton, Ontario (Drs deVeber and Chan); the Divisions of Neurology (Drs deVeber, MacGregor, and Curtis) and Hematology/Oncology (Mss Adams and Marzinotto, and Drs Leaker, Massicotte, and Andrew), The Hospital for Sick Children, Toronto, Ontario; and Richardson Laboratory, Queen's University, Kingston, Ontario (Dr Lillicrap).

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