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March 28, 2022
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Children with ischemic stroke at increased risk for autism

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Pediatric ischemic stroke increases the risk for autism, especially in children with comorbid epilepsy, according to results of a Swedish cohort study published in Neurology.

“The etiology of autism is complex and has been under intense examination pointing both to genetic and environmental causes, in some cases shown by abnormal structural development of the brain,” Heléne Sundelin, MD, PhD, of the neuropediatric unit at Karolinska Institute in Stockholm, and colleagues wrote. “Autism also shares risk factors with pediatric ischemic stroke, such as maternal and perinatal complications.”

Image of brain with ischemic stroke
Source: Adobe Stock

Sundelin and colleagues sought to examine the risk for autism in children with pediatric ischemic stroke, as well as their immediate relatives, by evaluating 1,322 individuals under the age of 18 years who had an ischemic stroke between 1969 and 2016, and were alive a week following the stroke, who were not previously diagnosed with autism.

Researchers compared 10 controls to each child with ischemic stroke, matching for sex, birth year and county of residence; they also identified first-degree relatives and their controls.

Results showed that 46 individuals (3.5%) were diagnosed with autism compared with 161 controls (1.2%), and there was no significant difference in risk for autism by age at stroke, either perinatal (adjusted HR = 2.69; 95% CI, 1.44-5.03) or during childhood (aHR = 3.18; 95% CI, 2.12-4.78).

Compared with controls, the risk for autism was elevated for those with ischemic stroke and comorbid epilepsy (aHR = 7.05; 95% CI, 3.74-13.3), as well as adverse motor outcome (aHR = 4.28; 95% CI, 2.44-7.51).

Further, after excluding preterm children or those small for gestational age, the increased risk for autism remained (aHR = 3.78; 95% CI, 2.55-5.6). Sex, gestational age or having a sibling with autism were not associated with autism in study participants.

“Children with ischemic stroke should readily be screened for autism if the disorder is suspected,” Sundelin and colleagues wrote.