Idiopathic Etiology

Despite the long list of known etiologies for childhood stroke, many children undergo an extensive stroke workup that is ultimately unrevealing. Depending on the extent of the diagnostic evaluation, as well as what is deemed an acceptable "etiology," the proportion of "idiopathic" ischemic strokes in hospital series ranges from 35% to 65% (55,57,59). Even in a prospective stroke study that conducted thorough diagnostic evaluations, 60% of children had no identifiable etiology (100). Our persistent inability to explain the strokes that occur in this large proportion of children reflects our limited understanding of the pathogenetic mechanisms underlying this disease.

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