Transient Ischemic Attack in Pediatric Patients with Moyamoya Disease: Clinical Features, Natural History and Predictors of Stroke

Publication date: Available online 5 July 2017
Source:Pediatric Neurology
Author(s): Meng Zhao, Dong Zhang, Shuo Wang, Yan Zhang, Rong Wang, Jizong Zhao
BackgroundDespite being the most common presentation in pediatric moyamoya patients, TIA in children has rarely been described. The clinical features and risk factors for stroke events of these TIAs remain unclear. The aim of the study is to describe the clinical characteristics of TIA in moyamoya children and explore the risk factors of stroke after TIA.Basic proceduresWe reviewed 696 consecutive moyamoya vasculopathy patients (155 pediatric patients and 541 adults) admitted to our hospital from 2009 to 2015 to identify pediatric moyamoya patients with initial presentations of TIAs. TIA characteristics were summarized. We defined recurrent TIAs that involve more types of symptoms or symptom extensions as symptom progression. The risk factors for subsequent stroke were analyzed using time-to-event analyses.Main findingsWe identified 60 pediatric moyamoya patients who had presented with TIA (initial presentation age, 10.0 ± 3.5 years). Motor weakness (n=51, [85%]) was the most common initial presentation in these patients. During follow-up, 55 patients (91.7%) had recurrent TIAs and 14 (23.3%) had subsequent strokes. We identified the female sex (HR, 5.08; 95% CI, 1.40–18.47; P=0.01), Suzuki's grade >3 (HR, 4.01; 95% CI, 1.16–13.82; P=0.03), and symptom progression (HR, 5.31; 95% CI, 1.65–17.14; P=0.01) as independent predictors of future stroke events.Principal conclusionsTIAs in pediatric moyamoya have a relatively high recurrence rate and are associated with subsequent stroke. We identified the female sex, Suzuki's grade > 3, and symptom progression as independent predictors of future strokes.



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