Common Inducing Factors of Ischemic Events Occurred in Pediatric with Ischemic Moyamoya Disease

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Abstract
Objective: This study aims to investigate the inducing factors that cause ischemic events and summarize the clinical features between TIA and infarction in pediatrics with ischemic MMD. Methods: A retrospective analysis was conducted from September 2015 to September 2021 in-patients and out-patients admitted to Xiangya Hospital of Central South University. Results: The results indicated that 74.1% (63/85) of patients had obvious inducing factors before the ischemic attack, among which fever accounted for 41.3% (26/63). TIA patients with obvious inducing factors accounted for 83.3% (25/30) cases, and cerebral infarction patients with obvious inducing factors accounted for 69.1% (38/55). The inducing factorof fever is significantly higher in patients with infarction than in those with TIA (p=0.0023). The inducing factors of crying (p=0.0006) and consumption of irritating foods (p=0.0018) are significantly higher in patients with TIA than infarction. The age was younger in patients with infarction than TIA (8.8 ± 0.7 vs 5.8 ± 0.5, p=0.0011). The infarctions were more common in patients with PCA involvement than in patients present with TIA (p=0.0044). Multivariate analysis revealed that crying (p= 0.002) was independently associated with TIA. Conclusions: The occurrence of ischemic events in children with ischemic MMD tends to be associated with a clear inducing factor. Fever is more common in causing cerebral infarction, while crying and eating irritating foods are easy to cause TIA. Crying was identified as an independent risk factor for inducing TIA. The patients present with infarction are associated with younger age and PCA involvement in pediatric ischemic MMD.

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