Pediatric Ischemic Stroke: An Infrequent Complication of SARS‐CoV‐2

Objective Severe complications of SARS-CoV-2 include arterial ischemic stroke (AIS) in adults and pediatric multisystem inflammatory syndrome. Whether stroke is a frequent complication of pediatric SARS-CoV-2 is unknown. This study aimed to determine the proportion of pediatric SARS-CoV-2 cases with ischemic stroke and the proportion of pediatric strokes with SARS-CoV-2 in the first three months of the pandemic in an international cohort. Methods We surveyed 61 international sites with pediatric stroke expertise. Survey questions included: numbers of hospitalized pediatric (≤18 years) SARS-CoV-2 patients; numbers of incident neonatal and childhood ischemic strokes; frequency of SARS-CoV-2 testing for pediatric stroke patients; and numbers of stroke cases positive for SARS-CoV-2 March 1-May 31, 2020. Results Of 42 centers with SAR-CoV-2 hospitalization numbers, 8/971 (0.82%) with SARS-CoV-2 had ischemic strokes. Proportions of stroke cases positive for SARS-CoV-2 from March-May 2020 were: 1/108 neonatal AIS (0.9%), 0/33 neonatal cerebral sinovenous thrombosis (CSVT; 0%), 6/166 childhood AIS (3.6%), and 1/54 childhood CSVT (1.9%) cases. However, only 30.5% of neonates and 60% of children with strokes were tested for SARS-CoV-2. Therefore, these proportions represent 2.9%, 0%, 6.1%, and 3.0% of stroke cases tested for SARS-CoV-2. Seven of eight with SARS-CoV-2 had additional established stroke risk factors. Interpretation As in adults, pediatric stroke is an infrequent complication of SARS-CoV-2, and SARS-CoV-2 was detected in only 4.7% of pediatric ischemic stroke patients tested. However,