SARS-CoV-2 Infection and Increased Risk for Pediatric Stroke - 20/11/22

Doi : 10.1016/j.pediatrneurol.2022.10.003

MaryGlen J. Vielleux, MD ^a,^b, Shanna Swartwood, MD ^a,^b, Dan Nguyen, MD ^c, Karen E. James, MD ^d, Bree Barbeau, MPH ^e, Joshua L. Bonkowsky, MD, PhD ^a,^b,^⁎
^a Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine
^b Brain and Spine Center, Primary Children's Hospital, Intermountain Healthcare
^c Department of Neurology, University of Utah School of Medicine
^d Division of Pediatric Rheumatology, Department of Pediatrics, University of Utah School of Medicine
^e Disease Response, Evaluation, Analysis, & Monitoring Program, Bureau of Epidemiology, Utah Department of Health

^∗Communications should be addressed to: Dr. Bonkowsky; Division of Pediatric Neurology; Department of Pediatrics; University of Utah School of Medicine; 295 Chipeta Way; Salt Lake City, Utah 84108.Division of Pediatric NeurologyDepartment of PediatricsUniversity of Utah School of Medicine295 Chipeta WaySalt Lake CityUtah84108

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Abstract

Background

There is an increased risk of stroke in adults with severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) infection, but whether there is a similar association with stroke in children is unclear. Our objective was to determine whether there is a correlation between COVID-19 infection, multisystem inflammatory syndrome in children (MIS-C), and pediatric ischemic stroke.

Methods

This was a retrospective, population-based cohort analysis between March 1, 2020, and June 30, 2021, conducted at a children's hospital. Pediatric patients with a diagnosis of ischemic stroke were identified using ICD-10 diagnoses of ischemic stroke, cerebrovascular accident, or cerebral infarction.

Results

We identified 16 patients, seven male and nine female, with ischemic stroke. Ages were 8 months to 17 years (median 11.5 years). More Asian (6%) and black (13%) patients had strokes compared with population prevalence (2% each, respectively). No patients had active COVID-19 infection. COVID-19 antibodies were identified in five of 11 patients tested (45%), of whom three were diagnosed with MIS-C. 82% of the strokes occurred between February and May 2021. The peak incidence was in February 2021, which was two months after peak incidence of pediatric cases of COVID-19 and one month after the peak of MIS-C cases.

Conclusions

Our study suggests that prior COVID-19 infection, but not acute infection, is correlated with a risk for stroke in the pediatric population. The risk for stroke appears to be distinct from the risk for MIS-C.

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Keywords : Coronavirus, COVID-19, Pediatric, Ischemic, Stroke, MIS-C

Plan

Introduction

Methods

Standard protocol approvals, registrations, and patient consents

Declaration of interests

	Conflict of Interest Disclosures: The authors have no conflicts of interest relevant to this article to disclose.
	Funding: No funding to report.
	Contributors' Statement: Drs. Vielleux, Swartwood, Nguyen, and James and Ms. Barbeau collected data, carried out the analyses, and reviewed and revised the manuscript. Dr. Bonkowsky conceptualized and designed the study, coordinated and supervised data collection, and drafted the initial manuscript. All authors provided edits to the manuscript, approved the final manuscript as submitted, and agree to be accountable for all aspects of the work.