Arteriopathy and stroke: What’s the connection?

Arteriopathy is a common cause of stroke in children

You might think of stroke as an older person’s problem, but this type of brain injury can affect kids, too. In fact, each year, an estimated up to 5 out of every 100,000 kids have a stroke. Many of these are arterial ischemic strokes, which result from obstruction of blood flow by clots, narrowed or damaged arteries or both. Here, Dr. Laura Lehman, Outpatient Medical Director of the Stroke and Cerebrovascular Center at Boston Children’s Hospital, shares what parents need to know about one of the more common causes of stroke.

Cerebral arteriopathies raise risk. These blood vessel abnormalities affect arteries in the brain and can include moyamoya disease, focal cerebral arteriopathy, arterial dissection and vasculitis. “Arteriopathies are the most common cause of arterial ischemic stroke in children,” says Dr. Lehman. At least one-third of children who experience an arterial ischemic stroke have some type of underlying cerebral arteriopathy. Unfortunately, most types of arteriopathy are silent and don’t have symptoms until they lead to a stroke. The exception is moyamoya disease, which can cause headaches, seizures or transient ischemic events, or “mini strokes,” in kids before a full-blown stroke.

Recurrence rates are high. For kids with cerebral arteriopathy, the risk of stroke remains high even after they’ve already experienced one. Research suggests that 1 in 4 children with an arteriopathy who have had a stroke will have another, often within just a few weeks or months of the initial event. For this reason, it’s crucial to stay in close contact with your child’s physician for regular follow-up appointments, says Dr. Lehman. “Every child who has had a stroke should undergo periodic imaging tests to keep an eye on any blood vessel abnormalities,” she explains.

Infection may play a role. Could having chickenpox put kids at risk for stroke? That’s the implication of one recent study of patients at hospitals including Boston Children’s, which found that children who had been infected with herpes viruses (one of which causes chickenpox) were twice as likely to experience an arterial ischemic stroke. While it’s too soon to say whether infections are responsible for arteriopathies in particular, it’s possible that that the inflammation they cause might affect blood vessel health.

Knowledge is power. While it might seem like there’s little you can do to prevent an initial stroke due to cerebral arteriopathy, parents can still take steps to protect against recurrent strokes. Talk with your child’s clinicians about imaging tests that can help identify arteriopathy, and consider surgery if the diagnosis is moyamoya. Parents should also watch for signs of stroke, such as weakness on one side of the body, difficulty speaking or walking and changes to their child’s mental state. And make sure your child adheres to their medication regimen as prescribed, says Dr. Lehman.

Learn about the Stroke and Cerebrovascular Center.