Cause of pediatric stroke may be overlooked in young adults
Awareness of focal cerebral arteriopathy, along with quick action and aggressive monitoring, is vital.
A significant cause of stroke in children may also affect young adults — and yet be overlooked by clinicians.
That warning comes from Heather Fullerton, MD, MAS, a pediatric vascular neurologist at the University of California, San Francisco Benioff Children’s Hospitals. Fullerton wants to raise awareness among clinicians about the importance of recognizing focal cerebral arteriopathy (FCA) across age groups.
FCA is one of the most common causes of arterial ischemic stroke in previously healthy children, typically appearing after a mild infection such as a cold or chickenpox. The condition is characterized by inflammation in the brain’s blood vessels, leading to narrowing or even complete blockage. It primarily affects one side of the brain’s anterior circulation and can progress rapidly from mild vessel changes to severe stenosis or occlusion within days. The median age of onset is around 11 years, but cases in pediatric studies range from toddlers to teenagers.
Fullerton is among the panelists speaking Wednesday at the session “‘And the Children Shall Lead Them … ’ Advances in Pediatric Stroke Research for Adult Stroke Neurologists.” Her presentation, “Focal Cerebral Arteriopathy: Is This Common Cause of Pediatric Stroke Being Missed in Young Adults?” underscores the importance of considering FCA beyond childhood years and the implications of overlooking the diagnosis.
“Although it seems to be a predominantly childhood disease, questions remain about whether it simply isn’t recognized in adults,” Fullerton said, noting that cases have been reported in young adults. “Its rapid progression can be devastating if not recognized promptly.”
Part of the goal of her session Wednesday is to draw more attention to the condition.
“We want people who take care of young adults to be aware of this,” Fullerton said. “Even if it’s rare, these cases matter because these are individuals with decades of life ahead.”
Another reason to raise awareness is that treatment settings for pediatric stroke are changing, she said. Increasingly, children with strokes are cared for at Stroke Centers, particularly because endovascular thrombectomy is available at those centers for children who have large vessel occlusions.
“Neurologists who treat children at these Comprehensive Stroke Centers aren’t necessarily familiar with the condition (FCA), and it does have implications for when you’re thinking about doing endovascular thrombectomy,” Fullerton said.
She noted that the stakes are high. FCA treatment relies on corticosteroids and aggressive supportive care, not surgical intervention. Endovascular therapy doesn’t seem to work well in FCA because the vessel walls are inflamed, Fullerton said, adding that neurointerventionalists report recurrent clot formation after successful clot removal in children with FCA.
Two large clinical trials — the U.S.-based FOCAS trial and Europe’s PASTA trial — are investigating the effectiveness of steroids in FCA or suspected FCA and optimal timing for treatment.
“Ten years ago, if a child was presenting to a pediatric hospital with a pediatric stroke program, often it was misdiagnosed as arterial dissection or sometimes called fibromuscular dysplasia,” Fullerton said. “So, it was really misdiagnosed even in children’s hospitals until recently.
“But now I would say within children’s hospitals, there’s a high level of awareness of this entity, especially because we have an ongoing active NIH StrokeNet trial that’s studying treatments for FCA.”
Awareness is essential, Fullerton said, because timing matters. When a child first presents with FCA, arteriopathy is often mild. Then it progresses dramatically within days. So close follow-up and imaging within three to seven days is crucial, she said. She also encourages clinicians to take additional supportive measures, including proper head positioning, fluids and blood pressure management to prevent further strokes during progression.
For clinicians, Fullerton’s message is clear: Be aware that FCA exists, act quickly and monitor aggressively. If FCA goes unrecognized, patients are at risk of recurrent strokes and long-term disability.
“Anyone who treats children or young adults wants to do their best to try to prevent a neurological deficit that they know is going to last for decades through somebody’s most productive life years,” she said. “These cases mean a lot to the clinicians who care for them.”
