Which of the following is a recognized contributor to pediatric stroke risk?

• A. Moyamoya arteriopathy
• B. Arterial dissection
• C. Sickle cell disease
• D. All of the above

Answer: (D)

Pediatric stroke risk is influenced by multiple conditions, including Moyamoya arteriopathy, arterial dissection, and sickle cell disease. Moyamoya arteriopathy causes progressive narrowing of the intracranial vessels and the development of fragile collateral networks, which can lead to cerebral ischemia in children and, less commonly, hemorrhagic events. Arterial dissection, which may follow trauma or occur spontaneously in children, can create local thrombus or emboli that culminate in a focal stroke. Sickle cell disease markedly raises stroke risk through chronic anemia, hemolysis, dehydration, and hyperviscosity, with microvascular occlusion and possible large-artery stenosis contributing to both ischemic and hemorrhagic strokes. Because each of these conditions is an established, recognized contributor to pediatric cerebrovascular events, the option that encompasses all of them best reflects the real-world landscape of pediatric stroke risk factors. Recognizing these diverse etiologies helps in early identification, preventive strategies, and prompt management when stroke presents.