1. Lack of Recurrence and Progressive Arteriopathy among Children with Cryptogenic Stroke Dr S. DARTEYRE, MD, MSc 1 Dr S. CHABRIER, MD, MSc 1 Pr. F. RIVIER, MD, PhD 2 1. CHU Saint Etienne. 2. CHU Montpellier Research Group on Thrombosis, EA 3065 National Centre for Pediatric Stroke

2. Lecture Plan Classification of Stroke in Young Adults. Classical Clinical Histories in Children. Study Hypothesis. Study Methods. Study Results. Discussion. Conclusion.

3. A Classical Dichotomy Adult Stroke Background. Stroke in Young Adults (< 40 y). Symptomatic Forms ( dissections… ). Cryptogenic Forms ( at least 40% ). Connecting Departments.

4. And Classical Histories… Lea, 5 years old. Right hemiparesis. Lateral Lenticulo Striate (LLS).M1 stenosis. Varicella. Aspirin. Good Recovery.

5. Study Hypothesis Are Childhood Cryptogenic Strokes doing Better than Symptomatic Ones ?

6. Study Methods (1) Age: 3 months to 16 years. Arterial Ischemic Strokes (AIS) Bernard Stroke 2012 Transient Ischemic Attacks (TIA) Albers NEJM 2002 Classification of Cerebral Arteriopathies Bernard Stroke 2012, Sébire Lancet 2006 – Dissections – Transient Cerebral Arteriopathies (TCA) – Post-Varicella Arteriopathies (PVA) – Moya-moya, others…

7. Study Methods (2) Symptomatic Clear Mechanism Cryptogenic No Clear Mechanism After Extensive Work-Up Risk Factors Only Altieri Stroke 2009

8. Study Methods (3) Inclusion: age, AIS or TIA. Retrospective, single center, ICD-9 and 10. Primary Endpoints: – Recurrences: new AIS/TIA 2 w after index stroke – Death. – NIS. Secondary Endpoints: – Radiological Evolution of Arteriopathies.

9. Lower extremity motor impairment absent = 0 light = 1 moderate = 2 severe = 3 Movement disorders present = 1 absent = 0 Behaviour troubles present = 1 absent = 0 Epilepsy absent = 0 benign = 1 severe = 2 Education/School normal = 0 school support = 1 institution = 2 Home support necessary = 1 not necessary = 0 Language disorders absent = 0 moderate = 1 severe = 2 Upper extremity motor impairment absent = 0 light = 1 moderate = 2 severe = 3 LONG-TERM NEUROLOGICAL IMPAIRMENT SCORE (NIS) TOTAL = / 15 0 - 5: minor impairment 5 - 10: moderate impairment 10 - 15: severe impairment

10. Results (1)

11. Results (2) SYMPTOMATIC ( N=35) Multiple AIS* Bilateral* Posterior Infarcts* Sylvian Superficial* Vertebral stenosis* Anticoagulation/Aspirin* Death = 1 Recurrence 30%* Mean NIS 4.2* Progressive Arteriopathies* CRYPTOGENIC (N=28) Single AIS* Unilateral* Anterior Infarcts* Sylvian Deep (LLS)* M1 focal stenosis* Aspirin alone* Death = 0 Recurrence 0%* Mean NIS 2.4* Non-Progressive Arteriopathies* *p < 0.05

12. * P < 0.05

14. Discussion Childhood Cryptogenic Strokes Do Better Than Symptomatic Ones Recurrences In Literature: 5-7% Idiopathic Sträter 2002, Fullerton 2007 Definition (timing) of Recurrences +++ PVA: symptomatic or cryptogenic ? Follow-Up Retrospective = Biases

15. Conclusion Childhood Cryptogenic Stroke. Multiple Risk Factors. Aspirin. To be Validated with EBM. Evidence – Ethics – Common Sense

16. Secondary Prevention for AIS European Survey stephane.darteyre@chu-st- etienne.fr stefdart@gmail.com