Cerebrovascular involvement in systemic childhood vasculitides

Pediatric vasculitides sometimes involve central nervous system (CNS). The manifestations are diverse, ranging from headache, seizures, vertigo, ataxia, behavioral changes, neuropsychiatric symptoms, consciousness disorders, and even cerebrovascular (CV) accidents that may lead to irreversible impai...

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Bibliographic Details
Published in:Clinical rheumatology 2023-10, Vol.42 (10), p.2733-2746
Main Authors: Held, Martina, Sestan, Mario, Kifer, Nastasia, Jelusic, Marija
Format: Article
Language:English
Subjects:
Arteriosclerosis
Ataxia
Cardiovascular Issues in Rheumatic Diseases
Central nervous system
Cerebrovascular diseases
Children
Medicine
Medicine & Public Health
Mental disorders
Morbidity
Pediatrics
Rehabilitation
Review Article
Rheumatology
Risk factors
Seizures
Stroke
Vasculitis
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Summary:Pediatric vasculitides sometimes involve central nervous system (CNS). The manifestations are diverse, ranging from headache, seizures, vertigo, ataxia, behavioral changes, neuropsychiatric symptoms, consciousness disorders, and even cerebrovascular (CV) accidents that may lead to irreversible impairment and even death. Stroke, on the other hand despite the great progress in prevention and treatment, is still one of the leading causes of morbidity and mortality in the general population. The aim of this article was to summarize CNS manifestations and CV issues observed in primary pediatric vasculitides and the current knowledge of etiology and CV risk factors, preventive strategies, and therapeutic options in this target patient population. Pathophysiological links reveal similar immunological mechanisms involved in both pediatric vasculitides and CV events with endothelial injury and damage being the central point. From the clinical point of view, CV events in pediatric vasculitides were associated with increased morbidity and poor prognosis. If damage has already occurred, the therapeutic approach consists of good management of the vasculitis itself, antiplatelet and anticoagulation therapy, and early rehabilitation. Risk factors for acquiring cerebrovascular disease (CVD) and stroke, particularly hypertension and early atherosclerotic changes, already begin in childhood, with vessel wall inflammation contributing itself, once more emphasizing that appropriate preventive measures are certainly necessary in pediatric vasculitis population to improve their long-term outcome.
ISSN:0770-3198
1434-9949
DOI:10.1007/s10067-023-06552-5