Stroke in children: first steps on the road to intervention.

Stroke in the infant and child, although not a new entity, is increasingly being recognized as one of the most common causes of morbidity in childhood, with reasonably consistent incidence figures of 2 to 3 per 100 000 population and suggested rates as high as 13 per 100 000.1,2 Importantly, stroke recurrence rates in children of 6% to as high as 40% have been reported in recent literature,3,4 most commonly in those with arteriopathy. In addition, the cause of stroke in childhood differs substantially from that in the adult and is far more heterogeneous, evolving over a period of time in which there is rapid development of the brain and vasculature. As a result, identification of stroke in children remains a challenge even for the tertiary care health professional,5 likely resulting in an underestimation of the overall incidence of this debilitating event. The significance of the article by Amlie-Lefond et al6 in this issue of Circulation is its recognition of the importance of the determination of predictive markers that are associated with arterial ischemic stroke and arteriopathy.