Vascular effects of Infection in Pediatric Stroke I (VIPS I)
Principal Investigator: Heather Fullerton
Funding: NIH-NINDS, R01 and Marc and Lynne Benioff Pediatric Stroke Research Fund
VIPS I began in August 2009 and ended in August 2016. The specific aims of VIPS I were:
1. To determine the association between infection and the arteriopathy observed in children with arterial ischemic stroke (AIS).
2. To prospectively determine if arteriopathy and inflammatory markers predict stroke recurrence.
VIPS I successfully enrolled and fully characterized 355 children with arterial ischemic stroke and 354 stroke-free controls from 37 centers on 5 continents. It has already led to 10 original manuscripts (8 published, 2 under review), representing the most scientifically rigorous body of work in the field of childhood stroke. We worked with Stanford University neuroradiologist, Dr. Max Wintermark, to establish novel and rigorous methods for prospectively diagnosing and classifying childhood arteriopathies using a combination of clinical and radiographic data (Wintermark, Stroke 2014). We confirmed the importance of arteriopathies as a predictor of recurrent stroke (Fullerton, Stroke 2016). We confirmed minor clinical infection as a transient risk factor for childhood (Fullerton, Neurology 2015), and found that herpes viral infections (not only varicella, but also herpes simplex) might play a particular role in childhood stroke (Elkind, Circulation 2016). We also found that serum inflammatory markers differ by stroke sub-type, and predict recurrent stroke risk (Fullerton, Stroke 2017). VIPS data led to the paradox of a common exposure (infection) and rare outcome (childhood stroke). We hypothesized that this paradox could be explained by (1) unusual strains or combinations of pathogens and/or (2) unusual host immune responses to infection, which was tested in VIPS II.
The Impact of Seizure in Pediatric Stroke I (SIPS I)
Principal Investigator: Christine Fox
Funding: Pediatric Epilepsy Research Foundation
SIPS I started in 2011 and ended in 2014. The specific aims of SIPS I were to measure in neonates and children with ischemic stroke:
1. The frequency, characteristics, and predictors of early (< 14 days) seizures.
2. The frequency, characteristics, and predictors (including presence of early seizures) of epilepsy/late seizures (i.e. chronic seizures occurring 14 days or longer after stroke).
3. The impact of early seizures of the development of epilepsy on adverse outcomes, including death and neurological disability at 3 months and 1 year.
Moyamoya Project
The Moyamoya Project at UCSF followed and collected data on Moyamoya patients. A registry was created for future research and data analysis purposes. Data collected included patient's stroke history, radiographic features, and pre/post surgery events.
Predicting Stroke after Trauma (PSAT)
Principal Investigators: Heather Fullerton and Christine Fox
Funding: American Heart Association
PSAT started in __ and ended in ___. The specific aims of PSAT were:
1. To estimate the 4-month incidence of ischemic stroke within a population-based cohort of children and young adults seeking emergency medical care for trauma and establish the time window of greatest risk.
2. To identify predictors of short-term stroke risk after trauma which do not depend on vascular imaging.
3. To design a large multi-center prospective study to develop a stroke prognostic score for victims of trauma and perform a single-center feasibility study of prospective data collection.