Cancer and Tumor-Associated Childhood Stroke: Results From the International Pediatric Stroke Study

Lisa R Sun; Alexandra Linds; Mukta Sharma; Mubeen Rafay; Sudhakar Vadivelu; Sarah Lee; Leonardo R Brandão; Brian Appavu; Jeremie H Estepp; Juliette Hukin; Sahar M A Hassanein; Anthony Chan; Lauren A Beslow; International Pediatric Stroke Study Group

doi:10.1016/j.pediatrneurol.2020.06.002

Cancer and Tumor-Associated Childhood Stroke: Results From the International Pediatric Stroke Study

Pediatr Neurol. 2020 Oct:111:59-65. doi: 10.1016/j.pediatrneurol.2020.06.002. Epub 2020 Jun 10.

Affiliations

¹ Division of Pediatric Neurology, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland; Division of Cerebrovascular Neurology, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland. Electronic address: lsun20@jhmi.edu.
² Division of Neurology, Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada.
³ Division of Hematology Oncology, Children's Mercy, University of Missouri Kansas City, Kansas City, Missouri.
⁴ Section of Pediatric Neurology, Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
⁵ Division of Neurosurgery, Department of Neurosurgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Neurosurgery, Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
⁶ Division of Child Neurology, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, California.
⁷ Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
⁸ Department of Child Health and Neurology, University of Arizona College of Medicine - Phoenix Barrow Neurologic Institute at Phoenix Children's Hospital, Phoenix, Arizona.
⁹ Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee; Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee.
¹⁰ Division of Neurology, Department of Pediatrics, Children's and Women's Health Centre, Vancouver, British Columbia, Canada; Division of Oncology, Department of Pediatrics, Children's and Women's Health Centre, Vancouver, British Columbia, Canada.
¹¹ Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
¹² Department of Paediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada.
¹³ Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

PMID: 32951663
DOI: 10.1016/j.pediatrneurol.2020.06.002

Abstract

Background: The prevalence of cancer among children with stroke is unknown. This study sought to evaluate cancer- and tumor-associated childhood ischemic stroke in a multinational pediatric stroke registry.

Methods: Children aged 29 days to less than 19 years with arterial ischemic stroke or cerebral sinovenous thrombosis enrolled in the International Pediatric Stroke Study between January 2003 and June 2019 were included. Data including stroke treatment and recurrence were compared between subjects with and without cancer using Wilcoxon rank sum and chi-square tests.

Results: Cancer or tumor was present in 99 of 2968 children (3.3%) with arterial ischemic stroke and 64 of 596 children (10.7%) with cerebral sinovenous thrombosis. Among children in whom cancer type was identified, 42 of 88 arterial ischemic stroke cases (48%) had brain tumors and 35 (40%) had hematologic malignancies; 45 of 58 cerebral sinovenous thrombosis cases (78%) had hematologic malignancies and eight (14%) had brain tumors. Of 54 cancer-associated arterial ischemic stroke cases with a known cause, 34 (63%) were due to arteriopathy and nine (17%) were due to cardioembolism. Of 46 cancer-associated cerebral sinovenous thrombosis cases with a known cause, 41 (89%) were related to chemotherapy-induced or other prothrombotic states. Children with cancer were less likely than children without cancer to receive antithrombotic therapy for arterial ischemic stroke (58% vs 80%, P = 0.007) and anticoagulation for cerebral sinovenous thrombosis (71% vs 87%, P = 0.046). Recurrent arterial ischemic stroke (5% vs 2%, P = 0.04) and cerebral sinovenous thrombosis (5% vs 1%, P = 0.006) were more common among children with cancer.

Conclusions: Cancer is an important risk factor for incident and recurrent childhood stroke. Stroke prevention strategies for children with cancer are needed.

Keywords: Arterial ischemic stroke; Cancer; Cerebral sinovenous thrombosis; Chemotherapy; Childhood stroke; Malignancy; Pediatric stroke.

Publication types

Clinical Study
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Anticoagulants / therapeutic use*
Antineoplastic Agents / therapeutic use*
Brain Neoplasms* / complications
Brain Neoplasms* / drug therapy
Brain Neoplasms* / epidemiology
Child
Child, Preschool
Comorbidity
Female
Fibrinolytic Agents / therapeutic use*
Hematologic Neoplasms* / complications
Hematologic Neoplasms* / drug therapy
Hematologic Neoplasms* / epidemiology
Humans
Infant
Infant, Newborn
Ischemic Stroke* / drug therapy
Ischemic Stroke* / epidemiology
Ischemic Stroke* / etiology
Male
Prevalence
Sinus Thrombosis, Intracranial* / chemically induced
Sinus Thrombosis, Intracranial* / drug therapy
Sinus Thrombosis, Intracranial* / epidemiology
Sinus Thrombosis, Intracranial* / etiology

Substances

Anticoagulants
Antineoplastic Agents
Fibrinolytic Agents