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Siegel DH, Tefft KA, Kelly T, Johnson C, Metry D, Burrows P, Pope E, Cordisco M, Holland KE, Maheshwari M, Keith P, Garzon M, Hess C, Frieden IJ, Fullerton HJ, Drolet BA. Stroke in Children With Posterior Fossa Brain Malformations, Hemangiomas, Arterial Anomalies, Coarctation of the Aorta and Cardiac Defects, and Eye Abnormalities (PHACE) Syndrome. Stroke 2012; 43:1672-4. [DOI: 10.1161/strokeaha.112.650952] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
PHACE is an acronym for posterior fossa brain malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities. Several case reports of arterial ischemic stroke (AIS) in individuals with PHACE have been published, but risk factors for AIS in PHACE have not been clearly defined. The objective of this article is to review all cases of stroke in PHACE in children and describe clinical characteristics that may be associated with an increased risk of AIS.
Methods—
A literature and registry search was conducted to identify patients with PHACE who had experienced AIS. Data were analyzed to determine age of onset, presenting signs and symptoms, and clinical features among this cohort compared with PHACE without AIS.
Results—
Twenty-two individuals with PHACE and AIS were identified. Imaging of the arteries of the head and neck was reported in 20 of 22. Narrowing or nonvisualization of at least 1 great cerebral vessel was present in 19 of 20 and of those, 15 had ≥2 vessels involved. Aortic arch anomalies were reported in 13 of 22 individuals.
Conclusions—
Aplasia, hypoplasia, or occlusion of a major cerebral artery appears to be a significant risk factor for AIS in children with PHACE, especially when >1 vessel is involved or if there is coarctation of the aorta.
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Affiliation(s)
- Dawn H. Siegel
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Kimberly A. Tefft
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Teresa Kelly
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Craig Johnson
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Denise Metry
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Patricia Burrows
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Elena Pope
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Maria Cordisco
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Kristen E. Holland
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Mohit Maheshwari
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Phillip Keith
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Maria Garzon
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Christopher Hess
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Ilona J. Frieden
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Heather J. Fullerton
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Beth A. Drolet
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
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