Rashes, Sniffles, and Stroke: A Role for Infection in Ischemic Stroke of Childhood

Major infections-sepsis, meningitis, encephalitis-have long been recognized as causes of pediatric arterial ischemic stroke. However, minor infections may also contribute to the pathogenesis of stroke, either by causing a systemic prothrombotic state or direct or indirect vascular injury. A focal cerebral arteriopathy has been identified in a large proportion of otherwise healthy children present with a first ischemic stroke. Both histologic data and small association studies suggest that varicella zoster virus can cause this childhood arteriopathy. Other viruses have been implicated in case reports. New data demonstrate an association between recent upper respiratory infection and this arteriopathy, suggesting a non-specific effect of infection. This manuscript reviews the evidence supporting a role for infection in ischemic stroke of childhood.