Inherited and acquired risk factors for arterial ischemic stroke in childhood

Ischemic stroke in childhood is a rare but serious disorder, which is associated with significant morbidity and mortality. The lack of causal homogeneity in the aetiology of this disorder presents problems for predicting and preventing it, making the ischemic stroke in childhood a real dilemma for the clinician. Although a variety of potential inherited and acquired causes have been now identified, including cardiac pathologies, infections, prothrombotic, metabolic and vascular disorders, the aetiology of ischemic stroke in the young remains still unknown in more than one third of the patients. Presently, an appropriate evaluation of some hypercoagulable conditions seems justified in adults with stroke. However, the etiologic contribution of several thrombophilic conditions to initial and recurrent stroke in affected children has not been definitely clarified, since more powerful and influential non-thrombophilic risk factors are usually present, making the thrombophilia screening in such circumstance a matter of debate. In particular, the diagnostic yield of the screening is reportedly lower in children, the role of several prothrombotic abnormalities is uncertain, especially in recurrent stroke, and there is no evidence-based guidance to stroke prevention and therapy in children carrying a hypercoagulable state. Additional studies are needed to quantify the risk for a cerebrovascular event in children with a prothrombotic disorder and to determine which combination of endogenous and exogenous risk factors leads to greater rates of initial and recurrent stroke.