Article Text

PDF
A right-to-left shunt in children with arterial ischaemic stroke
  1. Mirjana Perkovič Benedik1,
  2. Marjan Zaletel2,
  3. Nuška Pečarič Meglič3,
  4. Tomaž Podnar1
  1. 1Department of Paediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
  2. 2Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
  3. 3Department of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
  1. Correspondence to Tomaž Podnar, Department of Paediatrics, University Medical Centre Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia; tomaz.podnar{at}mf.uni-lj.si

Abstract

Objective To compare the prevalence and grade of right-to-left shunt (RLS) in children with arterial ischaemic stroke (AIS) and in controls.

Design Prospective study.

Setting Tertiary paediatric referral centre.

Patients 30 consecutive children with AIS.

Intervention Contrast transcranial Doppler (cTCD) with Valsalva manoeuvre was performed in children with AIS and in controls.

Main outcome measures Detection and quantification of RLS.

Results Logistic regression analysis showed that RLS was significantly associated with AIS and prothrombotic disorders or with AIS of undetermined aetiology (OR 6.10; 95% CI 1.41 to 26.3; p=0.015). The prevalence of RLS was significantly higher in a group of children with AIS and prothrombotic disorders or with AIS of undetermined aetiology compared to controls (p<0.05). Significantly more microembolic signals (MES) were detected in a group of children with AIS and prothrombotic disorders or with AIS of undetermined aetiology than in controls (p<0.005).

Conclusions Both the prevalence of RLS and number of detected MES were significantly higher in a group of children with AIS and prothrombotic disorders or with AIS of undetermined aetiology compared to controls. These findings suggest that paradoxical embolism may be an underestimated cause of AIS in children, particularly those with AIS and prothrombotic disorders or with AIS of undetermined aetiology.

Statistics from Altmetric.com

Footnotes

  • See Editorial p 409

  • Funding TP was supported in part by the Slovenian Agency for Research grant # P3-0343.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Committee of the Republic of Slovenia for Medical Ethics.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Editorial
    Fenella J Kirkham Anthony P Salmon Sachin Khambadkone