Researchers at the University of Calgary, Canada report 2 adolescents with focal cerebral arteriopathy (FCA), a stenosis of the large or medium-sized blood vessels, with marked elevations in inflammatory biomarkers. These compared to a case of nonarteriopathic arterial ischemic stroke (AIS) and normal adult serum. Case 1. A 14-year-old girl presented with acute left hemiparesis secondary to right MCA AIS. Vascular imaging revealed arteriopathy with irregular stenosis and dilatation of internal carotid, M1, M2, and A1 arteries without dissection. She recovered following anticoagulates and treatment with steroids and cyclophosphamide. Case 2. A healthy 15-year-old boy presented with aphasia and hemiparesis secondary to large left MCA AIS. A malignant cerebral edema required decompressive hemicraniectomy. Following treatment with aspirin and steroids the arteriopathy partially improved over months. Case 3. A 16-year-old female smoker after starting on contraceptives presented with right hemiplegia and left M1 thrombus without arteriopathy. Echocardiogram revealed a patent foramen ovale, and an embolism was presumed. At 6 months she is normal and taking aspirin.

Cytokine assays were quantified for each subject. Elevations of inflammatory markers were seen in acute phase of FCA cases but not in the embolic case. These elevations normalized following treatment. Quantitative analysis of serum cytokine is a useful biomarker in FCA and childhood stroke. [1]

COMMENT. An editorial comment questions whether the improvement in treated patients could be part of the natural history. In a recent series of 79 children with stroke due to FCA, 23% normalized, 77% stabilized or improved, and only 6% showed progression [2]. Studies in large cohorts are required to clarify the utility of measuring inflammatory markers in children with stroke.