Paediatric arterial ischaemic stroke during the COVID-19 pandemic: A collaborative north of England study

Background and Aims: SARS-CoV-2 as a possible cause for childhood arterial ischaemic stroke (AIS) has been described in a few case reports in literature. We sought to determine rates of AIS in paediatric patients across the North of England during a 12 month period, aiming to establish the underlying aetiology of their stroke. Methods: Tertiary paediatric neurosciences centres across the North of England (Manchester, Liverpool, Sheffield, Leeds, Newcastle) collected retrospective data on patients with AIS and collated information on the following areas: patient's age at presentation, aetiology, co-morbidities, COVID-19 status, imaging modalities, hyperacute therapy and any further management carried out. Results: From February 2020 to February 2021, 32 paediatric patients were diagnosed with AIS (age range 1 month-15 years, mean age 6.1 years). Aetiology consisted of idiopathic 29.1%, underlying vascular abnormality 25%, cardio-embolic 18.7%, post-operative complications 12.5%, coagulopathy 6.3%, infection 3.1%, and inflammatory/vasculitic 3.1%. At presentation and subsequent testing, 100% of patients were negative on COVID-19 PCR testing. Of note, one patient tested positive a month prior to admission, but negative on presentation and the stroke was not felt to be linked to COVID-19. Conclusions: Analysis of our regional data did not demonstrate that SARS-CoV-2 caused an increase in the number of patients diagnosed with AIS. Although COVID-19 testing is recommended in all patients presenting with AIS, we should not attribute the AIS to COVID-19 unless all other causes have been excluded.