{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:10:03Z","timestamp":1753891803020,"version":"3.41.2"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T00:00:00Z","timestamp":1743724800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Childhood stroke is a neurological emergency and an important cause of acquired brain injury and mortality in children. This retrospective study aimed to investigate the clinical presentation and neuroimaging features of arterial ischemic stroke (AIS) in children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively reviewed the records of pediatric AIS including neonates and children under 18\u202fyears of age from January 2008 to December 2023. Then we analyzed the gender and age distribution of AIS, as well as the clinical and neuroimaging characteristics and risk factors of AIS in different age groups. The study was approved by the Ethics Committee of the host institution.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Male patients predominated in both the neonatal AIS (NAIS) group and the pediatric AIS (PAIS) group. The majority of AIS children (73, 60.33%) were diagnosed after 24\u202fh of symptom onset. Seizures (82.35%) and limb weakness (77.88%) were the most common initial neurologic symptoms of NAIS and PAIS, respectively. Anterior circulation AIS alone was much more common than posterior circulation AIS alone in childhood AIS (79.34% vs. 9.92%). However, the NAIS group had a higher rate of infarctions that solely involved the cortex (52.94% vs. 20.19%). Perinatal hypoxia or asphyxia (23.5%) and minor head injury (28.85%) were the most common possible risk factors in NAIS and PAIS, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>AIS in children is male-predominant, and there is significant diagnostic delay in both NAIS and PAIS. NAIS and PAIS differ in clinical and neuroimaging manifestations, and risk factors. Notably, we also noted that the actual prevalence of AIS in children, and the diagnosis of certain risk factors, may be underestimated. Education and training will be necessary in both layperson and healthcare settings. Furthermore, prospective studies are required to explore this hypothesis.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1568684","type":"journal-article","created":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T10:37:37Z","timestamp":1743763057000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical and neuroimaging insights into childhood arterial ischemic stroke of different ages"],"prefix":"10.3389","volume":"16","author":[{"given":"Guanhao","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiang","family":"Ding","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bohao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qianhong","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mengmeng","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yafeng","family":"Liang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qianlei","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"243","DOI":"10.5603\/PJNNS.a2023.0034","article-title":"Polish recommendations for diagnosis and therapy of paediatric stroke","volume":"57","author":"Pilarska","year":"2023","journal-title":"Neurol Neurochir Pol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1097\/MOP.0000000000001294","article-title":"Epidemiology, causes, and morbidities of stroke in the young","volume":"35","author":"Janas","year":"2023","journal-title":"Curr Opin Pediatr"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e51","DOI":"10.1161\/STR.0000000000000183","article-title":"American Heart Association stroke council and council on cardiovascular and stroke nursing. Management of Stroke in neonates and children: a scientific statement from the American Heart Association\/American Stroke Association","volume":"50","author":"Ferriero","year":"2019","journal-title":"Stroke"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1543","DOI":"10.1161\/STROKEAHA.123.044827","article-title":"Global, regional, and National Burdens of stroke in children and adolescents from 1990 to 2019: a population-based study","volume":"55","author":"Sun","year":"2024","journal-title":"Stroke"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.braindev.2013.02.003","article-title":"Arterial ischemic stroke and hemorrhagic stroke in Chinese children: a retrospective analysis","volume":"36","author":"Xie","year":"2014","journal-title":"Brain and Development"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1248","DOI":"10.3760\/cma.j.cn112140-20220831-00770","article-title":"Expert consensus on diagnosis and treatment of pediatric arterial ischemic stroke","volume":"60","year":"2022","journal-title":"Zhonghua Er Ke Za Zhi"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1177\/1747493018799958","article-title":"Australian clinical consensus guideline: The diagnosis and acute management of childhood stroke","volume":"14","author":"Medley","year":"2019","journal-title":"Int J Stroke"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1016\/S1474-4422(21)00252-0","article-title":"2019 stroke collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the global burden of disease study 2019","volume":"20","year":"2021","journal-title":"Lancet Neurol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1038\/s41572-022-00337-x","article-title":"Childhood stroke","volume":"8","author":"Sporns","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/j.neurol.2019.03.005","article-title":"Arterial ischemic stroke in non-neonate children: diagnostic and therapeutic specificities","volume":"176","author":"Kossorotoff","year":"2020","journal-title":"Rev Neurol (Paris)"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"767","DOI":"10.23736\/S2724-5276.23.07301-9","article-title":"Clinical profiles of acute arterial ischemic neonatal stroke","volume":"76","author":"Mastrangelo","year":"2024","journal-title":"Minerva Pediatr (Torino)"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"611","DOI":"10.7499\/j.issn.1008-8830.2017.06.001","article-title":"Experts' consensus on the diagnosis and treatment of neonatal arterial ischemic stroke","volume":"19","year":"2017","journal-title":"Zhongguo Dang Dai Er Ke Za Zhi"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2644","DOI":"10.1161\/STROKEAHA.108.189696","article-title":"Management of stroke in infants and children: a scientific statement from a special writing Group of the American Heart Association Stroke Council and the council on cardiovascular disease in the young","volume":"39","author":"Roach","year":"2008","journal-title":"Stroke"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/s12883-022-02556-x","article-title":"Stroke in middle eastern children with cancer: prevalence and risk factors","volume":"22","author":"Zadeh","year":"2022","journal-title":"BMC Neurol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"4130","DOI":"10.1007\/s00330-020-07493-2","article-title":"Comparison of automated and manual DWI-ASPECTS in acute ischemic stroke: total and region-specific assessment","volume":"31","author":"Cheng","year":"2021","journal-title":"Eur Radiol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1111\/jon.13184","article-title":"Region-specific interobserver agreement of the Alberta stroke program early computed tomography score: a meta-analysis","volume":"34","author":"Zarrintan","year":"2024","journal-title":"J Neuroimaging"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1016\/S0140-6736(00)02237-6","article-title":"Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score","volume":"355","author":"Barber","year":"2000","journal-title":"Lancet"},{"key":"ref18","first-page":"41","article-title":"Stroke and gender","volume":"2","author":"Wyller","year":"1999","journal-title":"J Gend Specif Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1161\/STROKEAHA.108.521203","article-title":"Male predominance in childhood ischemic stroke: findings from the international pediatric stroke study","volume":"40","author":"Golomb","year":"2009","journal-title":"Stroke"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.pediatrneurol.2017.01.016","article-title":"Epidemiology and outcomes of arterial ischemic stroke in children: The Canadian pediatric ischemic stroke registry","volume":"69","author":"deVeber","year":"2017","journal-title":"Pediatr Neurol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1111\/j.1600-0404.2011.01514.x","article-title":"The gender gap in stroke: a meta-analysis","volume":"125","author":"Giralt","year":"2012","journal-title":"Acta Neurol Scand"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2100","DOI":"10.1038\/jcbfm.2012.141","article-title":"Sex differences in stroke","volume":"32","author":"Haast","year":"2012","journal-title":"J Cereb Blood Flow Metab"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1542\/pir.2016-0002","article-title":"Stroke in neonates and children","volume":"37","author":"Bernson-Leung","year":"2016","journal-title":"Pediatr Rev"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/j.jstrokecerebrovasdis.2009.03.013","article-title":"Diagnosis and management of pediatric arterial ischemic stroke","volume":"19","author":"Lopez-Vicente","year":"2010","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1007\/s11910-004-0027-3","article-title":"Cerebrovascular disorders in children","volume":"4","author":"Lynch","year":"2004","journal-title":"Curr Neurol Neurosci Rep"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1038\/jcbfm.2014.41","article-title":"Mechanisms of perinatal arterial ischemic stroke","volume":"34","author":"Fern\u00e1ndez-L\u00f3pez","year":"2014","journal-title":"J Cereb Blood Flow Metab"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1590\/S1679-45082015AO3056","article-title":"Perinatal ischemic stroke: a five-year retrospective study in a level-III maternity","volume":"13","author":"Machado","year":"2015","journal-title":"Einstein (Sao Paulo)"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e337","DOI":"10.1212\/WNL.0000000000008837","article-title":"Comparative study of posterior and anterior circulation stroke in childhood: results from the international pediatric stroke study","volume":"94","author":"Goeggel Simonetti","year":"2020","journal-title":"Neurology"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1177\/1747493018790064","article-title":"Recent developments and new frontiers in childhood arterial ischemic stroke","volume":"14","author":"Mackay","year":"2019","journal-title":"Int J Stroke"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.pediatrneurol.2008.11.002","article-title":"Risk factors for arterial ischemic and hemorrhagic stroke in childhood","volume":"40","author":"Wang","year":"2009","journal-title":"Pediatr Neurol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1111\/j.1747-4949.2012.00925.x","article-title":"International Paediatric stroke study group. International Paediatric stroke study: stroke associated with cardiac disorders","volume":"8","author":"Dowling","year":"2013","journal-title":"Int J Stroke"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.braindev.2007.05.002","article-title":"Risk factors and outcomes of childhood ischemic stroke in Taiwan","volume":"30","author":"Lee","year":"2008","journal-title":"Brain and Development"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1568684\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T10:37:50Z","timestamp":1743763070000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1568684\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,4]]},"references-count":32,"alternative-id":["10.3389\/fneur.2025.1568684"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1568684","relation":{},"ISSN":["1664-2295"],"issn-type":[{"type":"electronic","value":"1664-2295"}],"subject":[],"published":{"date-parts":[[2025,4,4]]},"article-number":"1568684"}}