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Pediatric Ischemic Stroke: An Infrequent Complication of SARS‐CoV‐2 – Beslow – – Annals of Neurology



Severe complications of SARS‐CoV‐2 include arterial ischemic stroke (AIS) in adults and pediatric multisystem inflammatory syndrome. Whether stroke is a frequent complication of pediatric SARS‐CoV‐2 is unknown. This study aimed to determine the proportion of pediatric SARS‐CoV‐2 cases with ischemic stroke and the proportion of pediatric strokes with SARS‐CoV‐2 in the first three months of the pandemic in an international cohort.


We surveyed 61 international sites with pediatric stroke expertise. Survey questions included: numbers of hospitalized pediatric (≤18 years) SARS‐CoV‐2 patients; numbers of incident neonatal and childhood ischemic strokes; frequency of SARS‐CoV‐2 testing for pediatric stroke patients; and numbers of stroke cases positive for SARS‐CoV‐2 March 1–May 31, 2020.


Of 42 centers with SAR‐CoV‐2 hospitalization numbers, 8/971 (0.82%) with SARS‐CoV‐2 had ischemic strokes. Proportions of stroke cases positive for SARS‐CoV‐2 from March–May 2020 were: 1/108 neonatal AIS (0.9%), 0/33 neonatal cerebral sinovenous thrombosis (CSVT; 0%), 6/166 childhood AIS (3.6%), and 1/54 childhood CSVT (1.9%) cases. However, only 30.5% of neonates and 60% of children with strokes were tested for SARS‐CoV‐2. Therefore, these proportions represent 2.9%, 0%, 6.1%, and 3.0% of stroke cases tested for SARS‐CoV‐2. Seven of eight with SARS‐CoV‐2 had additional established stroke risk factors.


As in adults, pediatric stroke is an infrequent complication of SARS‐CoV‐2, and SARS‐CoV‐2 was detected in only 4.7% of pediatric ischemic stroke patients tested. However, <50% of strokes were tested. SARS‐CoV‐2 testing should be considered in pediatric stroke patients as the pandemic continues to determine SARS‐CoV‐2’s role in pediatric stroke.

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