PT  - JOURNAL ARTICLE
AU  - Mirjana Perkovič Benedik
AU  - Marjan Zaletel
AU  - Nuška Pečarič Meglič
AU  - Tomaž Podnar
TI  - A right-to-left shunt in children with arterial ischaemic stroke
AID  - 10.1136/adc.2010.203992
DP  - 2011 May 01
TA  - Archives of Disease in Childhood
PG  - 461--467
VI  - 96
IP  - 5
4099  - http://adc.bmj.com/content/96/5/461.short
4100  - http://adc.bmj.com/content/96/5/461.full
SO  - Arch Dis Child2011 May 01; 96
AB  - 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.