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a Neurosciences Unit, Institute of Child
Health, University College London, UK, b Department of Haematology and
Oncology, Great Ormond Street Hospital for Children NHS Trust, London,
UK
Correspondence to: Dr V Ganesan, Newcomen Centre, Guys Hospital, St Thomas Street, London SE1 9RT, UK. Telephone 0044 171 955 5000; fax 0044 171 955 4950; e-mail v.ganesan{at}umds.ac.uk
Received 11 November 1997 and in revised form 19 March 1998;
Accepted 31 March
1998
OBJECTIVE
To investigate the prevalence of
currently recognised inherited prothrombotic states in a population of
children with arterial stroke.
METHODSChildren with arterial stroke presenting
to a tertiary level paediatric neurology centre between 1990 and 1996 were investigated for inherited prothrombotic states.
RESULTSSixty seven children with arterial stroke
were investigated. Abnormalities were initially identified in 16 patients; however, only eight children (12%) had an inherited
prothrombotic state. This was type 1 protein S deficiency in one
patient, the factor V Leiden mutation in six, and activated protein C
resistance (without the factor V Leiden mutation) in one. The
prevalence of the factor V Leiden mutation was not significantly higher
in children with arterial stroke (12%) than in a control population of
children without thrombosis attending the same institution (5.2%;
Fisher's exact test, p=0.19; difference in prevalence between patients and controls (95% confidence interval)=6.8% (
2.78% to 16.8%)).
CONCLUSIONSCurrently recognised inherited
prothrombotic tendencies were rarely associated with stroke in this
group of children, although larger numbers of patients would be needed
to confirm this. Age appropriate normal values should be used when
interpreting the results of a prothrombotic screen. Prothrombotic
abnormalities seen acutely are as often transient as inherited.
Longitudinal assessment and family studies are required before low
concentrations of an anticoagulant protein found acutely can be
attributed to an inherited abnormality.
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