To elucidate the male preponderance in pediatric stroke, researchers at University of Munster, Germany, Hospital for Sick Children Toronto, Canada, and other centers measured total testosterone in 72 children with arterial ischemic stroke (AIS), 52 with cerebral sinovenous thrombosis (CSVT), and in 109 healthy controls. Testosterone levels above the 90th percentile for age and gender were detected in 10 (13.9%) children with AIS and 10 (19.2%) with CSVT, totaling 16.7% with stroke, as compared with 2 (1.8%) controls (p=0.002). Adjusting for variables, elevated testosterone was independently associated with a 4-5-fold increased risk of stroke. The odds of cerebral thromboembolism ip boys was increased 1.3-fold for each lnm/L increase in testosterone. Testosterone levels were elevated less often in girls compared with boys (10.5% vs 20.9%) and not correlated with the risk of stroke. [1]

COMMENT. The male preponderance of pediatric stroke is associated with elevated endogenous testosterone levels. Studies in adults with increased risk of stroke related to anabolic/androgenic steroid abuse point to a testosterone-mediated hypercoaguability and platelet aggregation as a mechanism.

Investigation of mortality from childhood stroke in UK, 1921-2000, using the National Statistics database, found an initial decline followed by a steep rise in the 1940s. Subsequently, rates declined from the late 1960s onwards. Males had a higher mortality rate than females. Infants <1 year old had the highest rate that fell sharply in early childhood and rose again in late adolescence. Hemorrhagic stroke accounted for 71% stroke deaths. Mortality declined with each successive generation since the 1950s, suggesting the influence of prenatal or perinatal factors. [2]