Association of Cerebrovascular Accidents by Atrial Septal Defects in Patients Referred to Tabriz Children Hospital: a cross-sectional study

Association of Cerebrovascular Accidents by Atrial Septal Defects in Patients Referred to Tabriz Children Hospital: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association of Cerebrovascular Accidents by Atrial Septal Defects in Patients Referred to Tabriz Children Hospital: a cross-sectional study Shahram Sadeghvand, Sahar Hasanzadeh, Maryam Sanapour, Amirreza Naseri, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6449449/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Cerebrovascular accidents (CVAs) are often linked to hypertension, cerebrovascular disease, heart disease, and other various conditions. The rising prevalence of CVAs emphasizes the importance of raising awareness within the medical community. This study aims to explore the relationship between CVAs and atrial septal defects in pediatric patients referred to Tabriz Children's Hospital. Results: This study included 50 patients with an average age of 7.62±5.64 years-old. All CVAs observed in the study were ischemic. Among the participants, 58% were male. Cardiovascular diseases were identified as the most common cause of CVAs, accounting for 54% of cases. The most common clinical symptoms included muscle weakness (88%), gait disturbances (32%), loss of consciousness (30%), and speech disorders (25%). Conclusions: The present study found that cardiovascular diseases can be one of the primary causes of CVAs in children. Thus, it is essential to develop and carry out screening initiatives to facilitate immediate diagnosis and early intervention to prevent these incidents in younger patients. Moreover, future longitudinal studies with larger participant groups are suggested to advance this area of research. Neurology Pediatrics Stroke atrial septal defects Background Cerebrovascular accidents (CVAs) are defined as acute brain injuries resulting from vascular damage, which may occur due to hemorrhage or blockage of a cerebral blood vessel ( 1 ). Cerebrovascular diseases in children, unlike in adults, are not typically associated with atherosclerosis, hypertension, or complications of chronic diseases like diabetes. Although the prevalence of stroke in adults is much higher than in children (2.5 to 2.7 per 100,000 children annually compared to 100 to 300 per 100,000 adults), the existence of preventable causes in pediatric stroke underscores its importance in this age group ( 2 ). Delayed diagnosis or misdiagnosis of underlying factors, as well as structural differences in the nervous, coagulation, and vascular systems of children compared to adults, are key distinguishing factors of pediatric strokes. In over 75% of pediatric cerebrovascular events, an identifiable predisposing factor is present. The most common causes include congenital and acquired heart diseases, leukemia as a leading cause of hemorrhagic stroke in children. Other causes include Hemoglobin disorders; for instance, 5% of cases of sickle cell anemia are associated with stroke. Vascular abnormality, meningitis, vasculitis, varicella-zoster virus, Moya-Moya syndrome, pseudo-arterial dissection, coagulation disorders such as protein C and S deficiencies and particularly Factor V ( 5 ) Leiden, platelet disorders, metabolic and genetic diseases such as homocystinuria and mitochondrial disorders, as well as cerebral venous sinus thrombosis, are other causes of this condition ( 1 ). The association between atrial septal defects (ASDs) and adult cerebrovascular events is well established. However, cerebrovascular events in children have been studied less frequently, and their causes may vary ( 3 ). The prevalence of ASDs in the general population is relatively high, and these defects may play a role in cerebrovascular events. Individuals with ASDs have a tenfold increased risk of stroke compared to the general population ( 4 ). The mechanism behind this elevated risk involves blood clots passing from the venous system to the arterial system through the atrial septal defect, which can result in life-threatening complications, such as altered consciousness, syncope, seizures, paralysis, deafness, blindness, and sudden death ( 5 , 6 ). Considering the various causes of CVAs, the lack of comprehensive studies in children, the high prevalence of atrial septal defects, and the possible association of these defects with CVAs in children evaluating relevant findings can lead to early diagnosis and, especially, better management of these patients. Appropriate treatment can prevent disabilities in young individuals and protect the productive workforce of society. Consequently, an ongoing study is being conducted to investigate the association of ASDs in patients with cerebrovascular events who are referred to the pediatric Hospital. Methods This descriptive cross-sectional study was conducted at Tabriz Children's Hospital on patients hospitalized from 2011 to 2021. By employing the census sampling method, all patients under 18 who were referred to Tabriz Children's Hospital between 2011 and 2021 and had been diagnosed with CVAs by a specialist were included in this study. The diagnosis was determined through the evaluation of the clinical history, comprehensive physical examination, and imaging findings. Patients with incomplete records, which prevented the extraction of the necessary information, were excluded from the study. Data were extracted from patient's medical records over a one-year period using a checklist designed to encompass various aspects. This checklist included the patient's demographic information, clinical symptoms, physical examination findings, and paraclinical results. The checklist also considered factors associated with CVAs, such as known risk factors and family history. This research study obtained approval from the Ethics Committee of the Faculty of Medicine at Tabriz University of Medical Sciences under the ethics code IR.TBZMED.REC.1400.913. All procedures involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. Written informed consent was obtained from the parents or legal guardians of all participants before enrollment in the study. Statistical analysis: SPSS version 24 was used for the analysis of collected data. Descriptive statistics were employed to report qualitative data through frequency and percentage, and quantitative data were summarized using the mean and standard deviation. Results A total of 50 patients with CVA diagnoses were included in the study. As presented in Table 1 , the mean age of the patients was 7.62 ± 5.64 years, comprising 29 males (58%) and 21 females (42%). The most prevalent factor associated with CVA was cardiovascular disease, which took 54% of the cases. None of the 50 patients had a positive family history of CVA; however, six patients had a documented history of cardiovascular disease (Table 1 ). All CVA cases in this study were ischemic strokes, with no reported cases of hemorrhagic stroke. The most common symptoms observed in children with CVA included muscle weakness, gait disturbances, loss of consciousness, and speech disorders, with frequency of 88%, 32%, 30%, and 25%, respectively. Only one patient (2%) exhibited an abnormality on their ECG. Echocardiography was performed on 42 patients (84%), revealing that seven patients (14%) had ASD, and 14 patients (28%) had a patent foramen ovale (PFO). Additionally, echocardiography findings indicated that three patients had both ASD and PFO (Table 2 ). Table 1 Demographic information of participants Variable Category Statistics Age (years-old, mean ± SD) 7.62 ± 5.64 Sex Female 21 (42%) Male 29 (58%) Medical history History of cardiovascular disease 6 (12%) Familial history 0 (0%) CVA leading factor Coagulation disorders 3 (6%) Cardiovascular diseases 27 (54%) Infectious agents 2 (4%) Unknown leading factor 18 (36%) Table 2 clinical and Para clinical findings variable category N (%) Clinical sign Muscle weakness 44 (88%) Pallor 1 (2%) gait disturbance 16 (32%) Dysarthria 25 (50%) Impaired Consciousness 15 (30%) Urinary or fecal incontinence 3(6%) Vital sign SBP mmHg (mean ± SD) 99.59 ± 13.72 DBP mmHg (mean ± SD) 65.78 ± 11.43 HR (mean ± SD) 102.78 ± 10.80 stroke type Ischemic 50(100%) Hemorrhagic 0(0%) ECG Normal 49(98%) Abnormal 1(2%) Echocardiography ASD 7(14%) PFO 14(28%) Both of them 3(6%) SBP: systolic blood pressure, DBP: diastolic blood pressure, HR: heart rate, ASD: atrial septal defect, PFO: patent foramen ovale Discussion Our findings indicated that 58% of childhood CVA cases occurred in boys. Cardiovascular disorders were identified as the most common cause of CVA in children, with a rate of 54%. We did not identify any case of hemorrhagic stroke, and the common presenting symptoms included muscle weakness, gait disturbances, loss of consciousness, and speech disorders. The rate of ASD and PFO were 14% and 28%, respectively. Additionally, 6% of the study population had both ASD and PFO simultaneously. Stroke is a clinical diagnosis indicating cerebrovascular disease, defined as any cerebrovascular event that results in focal neurological deficits lasting longer than 24 hours ( 7 ). The key differences between pediatric and adult strokes lie in the structural characteristics of the nervous system, coagulation factors, and the cerebrovascular system in children compared to adults. Research indicates that more than 75% of CVAs in children have identifiable predisposing factors. The most prevalent among these factors are acquired and congenital heart diseases; leukemia is recognized as a significant cause of hemorrhagic strokes in pediatric populations. Hemoglobinopathies, including sickle cell anemia, account for approximately 5% of stroke cases. Other contributing factors include infections such as chickenpox, vasculitis, meningitis, moyamoya syndrome, various coagulation disorders, and metabolic and genetic conditions ( 8 , 9 ). In a study conducted by Chiang et al. in Taiwan in 2018, it was found that 77.8% of stroke patients had identifiable risk factors. The most prevalent risk factors were vascular disease, infections, and cardiac diseases ( 8 ). Rotta et al. identified congenital cardiomyopathy as the leading cause of strokes in children( 10 ), while deVeber et al. reported that 25% of stroke patients had congenital heart disease ( 11 ). Bernard et al. emphasized the significant role of procoagulant disorders and vascular arteriopathies in the pathogenesis of strokes ( 12 ). Similar to previous studies, our findings suggest that metabolic diseases, collagen vascular diseases, and infectious agents are relatively uncommon causes of CVAs in children. About 5 out of every 1,000 live births result in an ASD, a hole in the septum separating the right and left atrium. This defect allows high-pressure blood from the left atrium to flow into the right atrium and pulmonary artery, potentially leading to pulmonary artery hypertension over time, which can cause symptoms like shortness of breath and fatigue ( 13 ). Additionally, deoxygenated blood from the right atrium mixes with oxygenated blood in the left atrium, which reduces the oxygen levels in systemic circulation and leads to weakness during physical activity. Also, slow blood flow in the lower limbs can lead to small clots formation, which can enter the left atrium and systemic circulation in ASD patients, increasing the risk of blockages and ischemia in various organs and potentially causing strokes. All large ASDs need treatment, whether symptomatic or not, as untreated defects can lead to pulmonary hypertension, right-sided heart failure, and an increased risk of strokes in the future ( 14 ). Our study showed that 28% of the children had PFO. The PFO is a natural opening in all fetuses that typically closes in about 80% of people after birth. When chest pressure increases—coughing, sneezing, or straining—a gap between the atrial walls may reopen, allowing blood from the right and left atria to mix. Ordinarily, blood from the right side should be filtered through the lungs before entering the left atrium. If the PFO remains open, unfiltered blood can flow directly to the body, including critical organs, potentially causing complications like stroke, transient ischemic attacks (TIAs), and visual impairments ( 15 ). In a 2016 study by Bernard et al., the prevalence of PFO was found to be higher in children with cryptogenic ischemic strokes (28.7%) compared to those with known stroke causes (11.5%) and a control group without strokes (5.6%) ( 16 ). The primary strength of this study is its comprehensive inclusion of all children who experienced CVAs over a ten-year period. A significant limitation, however, is the cross-sectional design, which complicates the establishment of cause-and-effect relationships. Consequently, it is imperative to conduct more extensive retrospective and prospective cohort studies utilizing a multicenter approach in the future to better investigate these causal connections. Conclusion The present study indicates that cardiovascular diseases represent the predominant cause of CVAs in pediatric populations. Furthermore, ASD and PFO defects exhibit a notable prevalence among these children. Consequently, it is essential to develop and implement screening programs that facilitate rapid diagnosis and timely intervention for CVAs in this demographic. Abbreviations CVAs: Cerebrovascular accidents, ASD: Atrial septal defects, PFO: Patent foramen ovale, SBP: systolic blood pressure, DBP: diastolic blood pressure, HR: heart rate Declarations Ethics approval and consent to participate: This research study obtained approval from the Ethics Committee of the Faculty of Medicine at Tabriz University of Medical Sciences under the ethics code IR.TBZMED.REC.1400.913. All procedures performed in this study followed the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments. Written informed consent was obtained from the parents or legal guardians of all participants before enrollment in the study. Funding: This study supported by Tabriz Children Hospital, which provided access to hospital records necessary for data collection and analysis. Author Contribution S.S: conception and design of the work, S.H: writing original draft, M.S: acquisition and formal analysis, A.N: statically analysis and interpretation of data, A.D: writing original draft and review and editing, A.M: conception and revise. All authors read and approved the final manuscript. Acknowledgement The authors would like to express their gratitude to the Pediatric Health Research Center, Tabriz University of Medical Sciences, for their support and guidance throughout this study. We sincerely appreciate the cooperation of all participants and their families, as well as the medical staff at Tabriz Children Hospital for their assistance in data collection. Data Availability The datasets generated and/or analysed during the current study are not publicly available due to institutional policy restrictions but are available from the corresponding author on reasonable request. References Ashrafi M, Montazer Lotfe Elahi H, Dehghani M. Clinical and Paraclinical Findings of Cerebrovascular Accidents in Children Admitted to Pediatric Medical Center from 1993 till 2003. SSU_Journals. 2011;19(4):518-24. Rowland LP. Merritt's neurology: Lippincott Raven; 2000. Dowling MM, Ikemba CM. Intracardiac shunting and stroke in children: a systematic review. Journal of child neurology. 2011;26(1):72-82. Mandalenakis Z, Rosengren A, Lappas G, Eriksson P, Hansson PO, Dellborg M. Ischemic Stroke in Children and Young Adults With Congenital Heart Disease. J Am Heart Assoc. 2016;5(2). Epub 20160223. doi: 10.1161/jaha.115.003071. PubMed PMID: 26908411; PubMed Central PMCID: PMC4802444. Ciorba A, Corazzi V, Cerritelli L, Bianchini C, Scanelli G, Aimoni C. Patent foramen ovale as possible cause of sudden sensorineural hearing loss: a case report. Medical Principles and Practice. 2017;26(5):491-4. Ritter S, Tani LY, Etheridge SP, Williams RV, Craig JE, Minich LL. What is the yield of screening echocardiography in pediatric syncope? Pediatrics. 2000;105(5):e58-e. Numis AL, Fox CK. Arterial ischemic stroke in children: risk factors and etiologies. Current neurology and neuroscience reports. 2014;14:1-9. Chiang K-L, Cheng C-Y. Epidemiology, risk factors and characteristics of pediatric stroke: a nationwide population-based study. QJM: An International Journal of Medicine. 2018;111(7):445-54. Bowers KJ, Deveber GA, Ferriero DM, Roach ES, Vexler ZS, Maria BL. Cerebrovascular disease in children: recent advances in diagnosis and management. Journal of Child Neurology. 2011;26(9):1074-100. Rotta NT, Silva ARd, et al. Cerebrovascular disease in pediatric patients. Arquivos de neuro-psiquiatria. 2002;60:959-63. deveber G, editor Arterial ischemic strokes in infants and children: an overview of current approaches. Seminars in Thrombosis and Hemostasis; 2003: Copyright© 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New …. Bernard TJ, Goldenberg NA. Pediatric arterial ischemic stroke. Hematology/oncology clinics of North America. 2010;24(1):167-80. Geva T, Martins JD, Wald RM. Atrial septal defects. The Lancet. 2014;383(9932):1921-32. Fraisse A, Latchman M, et al. Atrial septal defect closure: indications and contra-indications. Journal of thoracic disease. 2018;10(Suppl 24):S2874. Koutroulou I, Tsivgoulis G, Tsalikakis D, Karacostas D, Grigoriadis N, Karapanayiotides T. Epidemiology of patent foramen ovale in general population and in stroke patients: a narrative review. Frontiers in neurology. 2020;11:281. Bernard TJ, Friedman NR, et al. Preparing for a “pediatric stroke alert”. Pediatric neurology. 2016;56:18-24. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6449449","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":453141848,"identity":"9d0e957f-c316-40fe-a98b-7712cb8d16ff","order_by":0,"name":"Shahram Sadeghvand","email":"","orcid":"","institution":"Pediatric Health Research Center, Tabriz university of Medical Sciences, Tabriz,","correspondingAuthor":false,"prefix":"","firstName":"Shahram","middleName":"","lastName":"Sadeghvand","suffix":""},{"id":453141849,"identity":"9513e874-f7c0-4ebe-b784-e5460b34f24d","order_by":1,"name":"Sahar Hasanzadeh","email":"","orcid":"","institution":"Student Research Committee, Tabriz University of Medical Sciences, Tabriz","correspondingAuthor":false,"prefix":"","firstName":"Sahar","middleName":"","lastName":"Hasanzadeh","suffix":""},{"id":453141852,"identity":"241ed441-1a93-4e1a-a5a6-f58b9a7ee906","order_by":2,"name":"Maryam Sanapour","email":"","orcid":"","institution":"Pediatric Health Research Center, Tabriz university of Medical Sciences, Tabriz,","correspondingAuthor":false,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Sanapour","suffix":""},{"id":453141853,"identity":"a05cf474-dfb8-41cd-a29c-5d7b3e9997ab","order_by":3,"name":"Amirreza Naseri","email":"","orcid":"","institution":"Student Research Committee, Tabriz University of Medical Sciences, Tabriz","correspondingAuthor":false,"prefix":"","firstName":"Amirreza","middleName":"","lastName":"Naseri","suffix":""},{"id":453141854,"identity":"6dc6fa68-2e28-40ff-979e-1aee660e6fee","order_by":4,"name":"Amirhosein Dadashzadeh Asl","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFElEQVRIie3NMUvDQBTA8RcObrq068lB8hVOArEu/Sw5AplCRA7EIYRCIC6hbqK06mcIQueTg7j4AbKK4JShUMhSKVonhwTq5nC/4Xg8+N8DMIz/iQMBCPYDgsufAej+wYclr/yviVX8SoaMZ6hat2mWuFe6ej9/+EzcG/3cQDqFEVO9CVVYHi1rLa0ykt7diktrEYUTqEPAo6D/jCKcEaxEDrHP7BUXOYt9ClgBJv2Fq4i3JbtMFOP2ZGsvuSjYWUdhN5xwRb4/L5Aoaewje8ZFyWJMrWI4Odb44vR+rsUt/ZCM1J6kLPImYh6SocR5yZ+atsvE43VYbUjqJO4ifGvW3dRxy/4EUO82ABi4YRiGYRziC1oKU9w8gVcwAAAAAElFTkSuQmCC","orcid":"","institution":"Student Research Committee, Tabriz University of Medical Sciences, Tabriz","correspondingAuthor":true,"prefix":"","firstName":"Amirhosein","middleName":"Dadashzadeh","lastName":"Asl","suffix":""},{"id":453141855,"identity":"2d6adbf1-2f1f-438e-89a2-6a30450d5dc9","order_by":5,"name":"Akbar Molaie","email":"","orcid":"","institution":"Pediatric Health Research Center, Tabriz university of Medical Sciences, Tabriz,","correspondingAuthor":false,"prefix":"","firstName":"Akbar","middleName":"","lastName":"Molaie","suffix":""}],"badges":[],"createdAt":"2025-04-14 23:38:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6449449/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6449449/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83424397,"identity":"f9f23e35-a571-4539-900e-f44b67080c42","added_by":"auto","created_at":"2025-05-26 03:47:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":483369,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6449449/v1/9aa8908d-0f1d-4331-b57a-4888041a20e8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eAssociation of Cerebrovascular Accidents by Atrial Septal Defects in Patients Referred to Tabriz Children Hospital: a cross-sectional study\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eCerebrovascular accidents (CVAs) are defined as acute brain injuries resulting from vascular damage, which may occur due to hemorrhage or blockage of a cerebral blood vessel (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Cerebrovascular diseases in children, unlike in adults, are not typically associated with atherosclerosis, hypertension, or complications of chronic diseases like diabetes. Although the prevalence of stroke in adults is much higher than in children (2.5 to 2.7 per 100,000 children annually compared to 100 to 300 per 100,000 adults), the existence of preventable causes in pediatric stroke underscores its importance in this age group (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Delayed diagnosis or misdiagnosis of underlying factors, as well as structural differences in the nervous, coagulation, and vascular systems of children compared to adults, are key distinguishing factors of pediatric strokes. In over 75% of pediatric cerebrovascular events, an identifiable predisposing factor is present. The most common causes include congenital and acquired heart diseases, leukemia as a leading cause of hemorrhagic stroke in children. Other causes include Hemoglobin disorders; for instance, 5% of cases of sickle cell anemia are associated with stroke. Vascular abnormality, meningitis, vasculitis, varicella-zoster virus, Moya-Moya syndrome, pseudo-arterial dissection, coagulation disorders such as protein C and S deficiencies and particularly Factor V (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Leiden, platelet disorders, metabolic and genetic diseases such as homocystinuria and mitochondrial disorders, as well as cerebral venous sinus thrombosis, are other causes of this condition (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe association between atrial septal defects (ASDs) and adult cerebrovascular events is well established. However, cerebrovascular events in children have been studied less frequently, and their causes may vary (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The prevalence of ASDs in the general population is relatively high, and these defects may play a role in cerebrovascular events. Individuals with ASDs have a tenfold increased risk of stroke compared to the general population (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The mechanism behind this elevated risk involves blood clots passing from the venous system to the arterial system through the atrial septal defect, which can result in life-threatening complications, such as altered consciousness, syncope, seizures, paralysis, deafness, blindness, and sudden death (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConsidering the various causes of CVAs, the lack of comprehensive studies in children, the high prevalence of atrial septal defects, and the possible association of these defects with CVAs in children evaluating relevant findings can lead to early diagnosis and, especially, better management of these patients. Appropriate treatment can prevent disabilities in young individuals and protect the productive workforce of society. Consequently, an ongoing study is being conducted to investigate the association of ASDs in patients with cerebrovascular events who are referred to the pediatric Hospital.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis descriptive cross-sectional study was conducted at Tabriz Children's Hospital on patients hospitalized from 2011 to 2021. By employing the census sampling method, all patients under 18 who were referred to Tabriz Children's Hospital between 2011 and 2021 and had been diagnosed with CVAs by a specialist were included in this study. The diagnosis was determined through the evaluation of the clinical history, comprehensive physical examination, and imaging findings. Patients with incomplete records, which prevented the extraction of the necessary information, were excluded from the study. Data were extracted from patient's medical records over a one-year period using a checklist designed to encompass various aspects. This checklist included the patient's demographic information, clinical symptoms, physical examination findings, and paraclinical results. The checklist also considered factors associated with CVAs, such as known risk factors and family history. This research study obtained approval from the Ethics Committee of the Faculty of Medicine at Tabriz University of Medical Sciences under the ethics code IR.TBZMED.REC.1400.913. All procedures involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. Written informed consent was obtained from the parents or legal guardians of all participants before enrollment in the study.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis:\u003c/h2\u003e \u003cp\u003eSPSS version 24 was used for the analysis of collected data. Descriptive statistics were employed to report qualitative data through frequency and percentage, and quantitative data were summarized using the mean and standard deviation.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 50 patients with CVA diagnoses were included in the study. As presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the mean age of the patients was 7.62\u0026thinsp;\u0026plusmn;\u0026thinsp;5.64 years, comprising 29 males (58%) and 21 females (42%). The most prevalent factor associated with CVA was cardiovascular disease, which took 54% of the cases. None of the 50 patients had a positive family history of CVA; however, six patients had a documented history of cardiovascular disease (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). All CVA cases in this study were ischemic strokes, with no reported cases of hemorrhagic stroke. The most common symptoms observed in children with CVA included muscle weakness, gait disturbances, loss of consciousness, and speech disorders, with frequency of 88%, 32%, 30%, and 25%, respectively. Only one patient (2%) exhibited an abnormality on their ECG. Echocardiography was performed on 42 patients (84%), revealing that seven patients (14%) had ASD, and 14 patients (28%) had a patent foramen ovale (PFO). Additionally, echocardiography findings indicated that three patients had both ASD and PFO (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic information of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStatistics\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years-old, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.62\u0026thinsp;\u0026plusmn;\u0026thinsp;5.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (42%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (58%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMedical history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHistory of cardiovascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (12%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamilial history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eCVA leading factor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCoagulation disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardiovascular diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (54%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfectious agents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnknown leading factor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (36%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eclinical and Para clinical findings\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003evariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eClinical sign\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuscle weakness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (88%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePallor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003egait disturbance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (32%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDysarthria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (50%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImpaired Consciousness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (30%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrinary or fecal incontinence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eVital sign\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSBP mmHg (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.59\u0026thinsp;\u0026plusmn;\u0026thinsp;13.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDBP mmHg (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.78\u0026thinsp;\u0026plusmn;\u0026thinsp;11.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102.78\u0026thinsp;\u0026plusmn;\u0026thinsp;10.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003estroke type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIschemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHemorrhagic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eECG\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49(98%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbnormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eEchocardiography\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eASD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(14%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePFO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(28%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoth of them\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eSBP: systolic blood pressure, DBP: diastolic blood pressure, HR: heart rate, ASD: atrial septal defect, PFO: patent foramen ovale\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur findings indicated that 58% of childhood CVA cases occurred in boys. Cardiovascular disorders were identified as the most common cause of CVA in children, with a rate of 54%. We did not identify any case of hemorrhagic stroke, and the common presenting symptoms included muscle weakness, gait disturbances, loss of consciousness, and speech disorders. The rate of ASD and PFO were 14% and 28%, respectively. Additionally, 6% of the study population had both ASD and PFO simultaneously.\u003c/p\u003e \u003cp\u003eStroke is a clinical diagnosis indicating cerebrovascular disease, defined as any cerebrovascular event that results in focal neurological deficits lasting longer than 24 hours (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The key differences between pediatric and adult strokes lie in the structural characteristics of the nervous system, coagulation factors, and the cerebrovascular system in children compared to adults. Research indicates that more than 75% of CVAs in children have identifiable predisposing factors. The most prevalent among these factors are acquired and congenital heart diseases; leukemia is recognized as a significant cause of hemorrhagic strokes in pediatric populations. Hemoglobinopathies, including sickle cell anemia, account for approximately 5% of stroke cases. Other contributing factors include infections such as chickenpox, vasculitis, meningitis, moyamoya syndrome, various coagulation disorders, and metabolic and genetic conditions (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn a study conducted by Chiang et al. in Taiwan in 2018, it was found that 77.8% of stroke patients had identifiable risk factors. The most prevalent risk factors were vascular disease, infections, and cardiac diseases (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Rotta et al. identified congenital cardiomyopathy as the leading cause of strokes in children(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), while deVeber et al. reported that 25% of stroke patients had congenital heart disease (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Bernard et al. emphasized the significant role of procoagulant disorders and vascular arteriopathies in the pathogenesis of strokes (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Similar to previous studies, our findings suggest that metabolic diseases, collagen vascular diseases, and infectious agents are relatively uncommon causes of CVAs in children.\u003c/p\u003e \u003cp\u003eAbout 5 out of every 1,000 live births result in an ASD, a hole in the septum separating the right and left atrium. This defect allows high-pressure blood from the left atrium to flow into the right atrium and pulmonary artery, potentially leading to pulmonary artery hypertension over time, which can cause symptoms like shortness of breath and fatigue (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Additionally, deoxygenated blood from the right atrium mixes with oxygenated blood in the left atrium, which reduces the oxygen levels in systemic circulation and leads to weakness during physical activity. Also, slow blood flow in the lower limbs can lead to small clots formation, which can enter the left atrium and systemic circulation in ASD patients, increasing the risk of blockages and ischemia in various organs and potentially causing strokes. All large ASDs need treatment, whether symptomatic or not, as untreated defects can lead to pulmonary hypertension, right-sided heart failure, and an increased risk of strokes in the future (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur study showed that 28% of the children had PFO. The PFO is a natural opening in all fetuses that typically closes in about 80% of people after birth. When chest pressure increases\u0026mdash;coughing, sneezing, or straining\u0026mdash;a gap between the atrial walls may reopen, allowing blood from the right and left atria to mix. Ordinarily, blood from the right side should be filtered through the lungs before entering the left atrium. If the PFO remains open, unfiltered blood can flow directly to the body, including critical organs, potentially causing complications like stroke, transient ischemic attacks (TIAs), and visual impairments (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In a 2016 study by Bernard et al., the prevalence of PFO was found to be higher in children with cryptogenic ischemic strokes (28.7%) compared to those with known stroke causes (11.5%) and a control group without strokes (5.6%) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe primary strength of this study is its comprehensive inclusion of all children who experienced CVAs over a ten-year period. A significant limitation, however, is the cross-sectional design, which complicates the establishment of cause-and-effect relationships. Consequently, it is imperative to conduct more extensive retrospective and prospective cohort studies utilizing a multicenter approach in the future to better investigate these causal connections.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe present study indicates that cardiovascular diseases represent the predominant cause of CVAs in pediatric populations. Furthermore, ASD and PFO defects exhibit a notable prevalence among these children. Consequently, it is essential to develop and implement screening programs that facilitate rapid diagnosis and timely intervention for CVAs in this demographic.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCVAs: Cerebrovascular accidents, ASD: Atrial septal defects, PFO: Patent foramen ovale, SBP: systolic blood pressure, DBP: diastolic blood pressure, HR: heart rate\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e \u003cp\u003e\nThis research study obtained approval from the Ethics Committee of the Faculty of Medicine at Tabriz University of Medical Sciences under the ethics code IR.TBZMED.REC.1400.913. All procedures performed in this study followed the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments. Written informed consent was obtained from the parents or legal guardians of all participants before enrollment in the study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis study supported by Tabriz Children Hospital, which provided access to hospital records necessary for data collection and analysis.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.S: conception and design of the work, S.H: writing original draft, M.S: acquisition and formal analysis, A.N: statically analysis and interpretation of data, A.D: writing original draft and review and editing, A.M: conception and revise. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to express their gratitude to the Pediatric Health Research Center, Tabriz University of Medical Sciences, for their support and guidance throughout this study. We sincerely appreciate the cooperation of all participants and their families, as well as the medical staff at Tabriz Children Hospital for their assistance in data collection.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to institutional policy restrictions but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAshrafi M, Montazer Lotfe Elahi H, Dehghani M. Clinical and Paraclinical Findings of Cerebrovascular Accidents in Children Admitted to Pediatric Medical Center from 1993 till 2003. SSU_Journals. 2011;19(4):518-24.\u003c/li\u003e\n\u003cli\u003eRowland LP. Merritt\u0026apos;s neurology: Lippincott Raven; 2000.\u003c/li\u003e\n\u003cli\u003eDowling MM, Ikemba CM. Intracardiac shunting and stroke in children: a systematic review. Journal of child neurology. 2011;26(1):72-82.\u003c/li\u003e\n\u003cli\u003eMandalenakis Z, Rosengren A, Lappas G, Eriksson P, Hansson PO, Dellborg M. Ischemic Stroke in Children and Young Adults With Congenital Heart Disease. J Am Heart Assoc. 2016;5(2). Epub 20160223. doi: 10.1161/jaha.115.003071. PubMed PMID: 26908411; PubMed Central PMCID: PMC4802444.\u003c/li\u003e\n\u003cli\u003eCiorba A, Corazzi V, Cerritelli L, Bianchini C, Scanelli G, Aimoni C. Patent foramen ovale as possible cause of sudden sensorineural hearing loss: a case report. Medical Principles and Practice. 2017;26(5):491-4.\u003c/li\u003e\n\u003cli\u003eRitter S, Tani LY, Etheridge SP, Williams RV, Craig JE, Minich LL. What is the yield of screening echocardiography in pediatric syncope? Pediatrics. 2000;105(5):e58-e.\u003c/li\u003e\n\u003cli\u003eNumis AL, Fox CK. Arterial ischemic stroke in children: risk factors and etiologies. Current neurology and neuroscience reports. 2014;14:1-9.\u003c/li\u003e\n\u003cli\u003eChiang K-L, Cheng C-Y. Epidemiology, risk factors and characteristics of pediatric stroke: a nationwide population-based study. QJM: An International Journal of Medicine. 2018;111(7):445-54.\u003c/li\u003e\n\u003cli\u003eBowers KJ, Deveber GA, Ferriero DM, Roach ES, Vexler ZS, Maria BL. Cerebrovascular disease in children: recent advances in diagnosis and management. Journal of Child Neurology. 2011;26(9):1074-100.\u003c/li\u003e\n\u003cli\u003eRotta NT, Silva ARd, et al. Cerebrovascular disease in pediatric patients. Arquivos de neuro-psiquiatria. 2002;60:959-63.\u003c/li\u003e\n\u003cli\u003edeveber G, editor Arterial ischemic strokes in infants and children: an overview of current approaches. Seminars in Thrombosis and Hemostasis; 2003: Copyright\u0026copy; 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New \u0026hellip;.\u003c/li\u003e\n\u003cli\u003eBernard TJ, Goldenberg NA. Pediatric arterial ischemic stroke. Hematology/oncology clinics of North America. 2010;24(1):167-80.\u003c/li\u003e\n\u003cli\u003eGeva T, Martins JD, Wald RM. Atrial septal defects. The Lancet. 2014;383(9932):1921-32.\u003c/li\u003e\n\u003cli\u003eFraisse A, Latchman M, et al. Atrial septal defect closure: indications and contra-indications. Journal of thoracic disease. 2018;10(Suppl 24):S2874.\u003c/li\u003e\n\u003cli\u003eKoutroulou I, Tsivgoulis G, Tsalikakis D, Karacostas D, Grigoriadis N, Karapanayiotides T. Epidemiology of patent foramen ovale in general population and in stroke patients: a narrative review. Frontiers in neurology. 2020;11:281.\u003c/li\u003e\n\u003cli\u003eBernard TJ, Friedman NR, et al. Preparing for a \u0026ldquo;pediatric stroke alert\u0026rdquo;. Pediatric neurology. 2016;56:18-24.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Neurology, Pediatrics, Stroke, atrial septal defects","lastPublishedDoi":"10.21203/rs.3.rs-6449449/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6449449/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Cerebrovascular accidents (CVAs) are often linked to hypertension, cerebrovascular disease, heart disease, and other various conditions. The rising prevalence of CVAs emphasizes the importance of raising awareness within the medical community. This study aims to explore the relationship between CVAs and atrial septal defects in pediatric patients referred to Tabriz Children's Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e This study included 50 patients with an average age of 7.62±5.64 years-old. All CVAs observed in the study were ischemic. Among the participants, 58% were male. Cardiovascular diseases were identified as the most common cause of CVAs, accounting for 54% of cases. The most common clinical symptoms included muscle weakness (88%), gait disturbances (32%), loss of consciousness (30%), and speech disorders (25%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe present study found that cardiovascular diseases can be one of the primary causes of CVAs in children. Thus, it is essential to develop and carry out screening initiatives to facilitate immediate diagnosis and early intervention to prevent these incidents in younger patients. Moreover, future longitudinal studies with larger participant groups are suggested to advance this area of research.\u003c/p\u003e","manuscriptTitle":"Association of Cerebrovascular Accidents by Atrial Septal Defects in Patients Referred to Tabriz Children Hospital: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-11 07:46:11","doi":"10.21203/rs.3.rs-6449449/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b2cc420-ee9d-4a56-897e-285d5c2d1382","owner":[],"postedDate":"May 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-26T03:39:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-11 07:46:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6449449","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6449449","identity":"rs-6449449","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}