About

Rebecca N. Ichord, MD, is a Professor and CE of Neurology at the Perelman School of Medicine at the University of Pennsylvania. She is an attending neurologist at The Children's Hospital of Philadelphia, where she also serves as the Director of the Pediatric Stroke Fellowship Program and the Pediatric Stroke Program. Her clinical expertise focuses on childhood stroke and acute brain injury due to cardiac arrest and traumatic brain injury. As the director of the CHOP Stroke Program, she oversees clinical stroke care through a 24/7 neurovascular consultation service and a multidisciplinary outpatient stroke follow-up clinic, involving a team of specialists including vascular neurologists, neonatal neurologists, pediatric physiatrists, rehab therapists, speech/language pathologists, neuropsychologists, social workers, nurses, and educators. Her research primarily concentrates on stroke in childhood, including arterial ischemic stroke, intracranial hemorrhage, cerebral venous thrombosis, and related cerebral vascular disorders. Her active research activities include studying the vascular effects of infection in pediatric stroke, language and visual-spatial function after perinatal stroke, and the safety and effectiveness of constraint-induced therapy for infants following perinatal stroke. She collaborates locally and nationally on related research topics such as hypothermia for pediatric cardiac arrest, cerebrovascular complications of device-support for cardiac failure, and neuromonitoring strategies in pediatric intensive care.

Research topics

• Cognitive psychology
• Psychology
• Audiology
• Medicine
• Developmental psychology
• Linguistics
• Neuroscience

Selected publications

• Calretinin and Parvalbumin Trapping of TDP43 and XRCC1 Instructs Neocortical Interneuron Death in Neonatal Hypoxic-Ischemic Encephalopathy

  Biomolecules · 2026-04-22

  articleOpen access

  We examined neocortical pathology and interneuron degeneration in neonatal hypoxia-ischemic encephalopathy (HIE). Piglets in two age groups (2–3 or 7–10 days old, n = 4–12/group) underwent global cerebral hypoxia–ischemia (HI) or sham treatment. Piglets (2–3 days old) had epidural electrodes for continuous electroencephalography (cEEG) and were treated with hypothermia (HT) or remained at normothermia (NT). Older piglets, all NT, had scalp EEG. Piglets at both ages had seizures and survived for 1–7 days. Cortical damage was assessed by hematoxylin & eosin staining and immunohistochemistry; calretinin (CR), parvalbumin (PV), and vasoactive intestinal peptide (VIP) interneurons (INs) were counted. Cell injury was assessed by DNA fragmentation and protein nitration. TAR DNA binding protein-43 (TDP43) and the DNA repair scaffold protein X-ray repair cross complementing-1 (XRCC1) were examined for degeneration mechanisms. Cortical layers 3 and 4 showed high vulnerability; damage emerged as isolated cells, focal and laminar, and distributed as panlaminar throughout different cortical regions that correlated with seizure burden. HT protected strongly against cortical damage. CR- and PV-INs were severely depleted in HI-NT piglets compared to sham. VIP INs appeared invulnerable. HT partially rescued the loss of INs. CR and PV formed nuclear and cytoplasmic inclusions that colocalized with TDP43 and XRCC1; co-immunoprecipitation identified interactions among these proteins, and tyrosine nitration of CR. CR and PV INs accumulated DNA single- and double-strand breaks and appeared as attritional apoptosis variants with proteinopathy. This cell death is identified as aggreosis. IN loss correlated with seizure presence. Postmortem human neonatal HIE cases had a similar loss of CR and PV INs and nuclear depletion of TDP43 in the neocortex. Thus, neonatal HIE causes the loss of neocortical inhibitory IN subtypes with vulnerabilities instructed by their intrinsic calcium-binding protein signature and by mechanisms consistent with toxic sequestration and the nuclear depletion of XRCC1 and TDP43 underlying DNA damage accumulation. Early inhibitory IN deletion could drive seizure evolution in HIE; TDP43 and XRCC1 could be therapeutic targets for neonatal HIE.

  PublisherOA PDFDOI

• FLAIR Vascular Hyperintensities as Imaging Biomarker in Pediatric Acute Ischemic Stroke

  Stroke · 2025-03-28 · 3 citations

  article

  BACKGROUND: Fluid-attenuated inversion recovery vascular hyperintensities (FVH) are high signal intensities on magnetic resonance imaging resulting from sluggish or stagnant flow through vessels. This investigation describes the prevalence, risk factors, and outcomes associated with FVH in pediatric arterial ischemic stroke (AIS). METHODS: Retrospective review of children aged 29 days to 18 years in a single institution stroke registry from 2006 to 2022 with AIS. Magnetic resonance imaging were assessed for large vessel occlusion (LVO), FVH score, modified Alberta Stroke Program Early CT Score, and AIS volume. The association between demographic and imaging factors with the presence of and high FVH burden was assessed using Fisher exact, Pearson χ 2 , or Kruskal-Wallis tests. Wilcoxon rank-sum test evaluated the association of FVH score with the presence of LVO and poor outcome. The relationship between FVH score and age, time to magnetic resonance imaging, stroke volume, modified Alberta Stroke Program Early CT Score, Pediatric National Institutes of Health Stroke Scale, and Pediatric Stroke Outcome Measure score were assessed using Spearman correlation. A multivariable logistic regression was used to evaluate predictors of FVH. RESULTS: In total, 273 patients with AIS were screened, and 83 met the inclusion criteria. Patients were a median age of 11.6 years (range, 1 month–18 years) and 37% were female. FVH were present in 53% of the cohort. Median FVH score was 0 (interquartile range, 0–2) in those without LVO and 5.5 (interquartile range, 3–7) in those with LVO ( P <0.0001). There was a positive correlation between FVH score and Pediatric National Institutes of Health Stroke Scale ( r s =0.40; P =0.003), modified Alberta Stroke Program Early CT Score ( r s =0.62; P <0.0001), stroke volume ( r s =0.58; P <0.0001) and Pediatric Stroke Outcome Measure at 1 year ( r s =0.32; P =0.012). In the multivariable logistic regression, older age (odds ratio, 1.38 [95% CI, 1.08–1.77]; P =0.009) and the presence of LVO (odds ratio, 301.97 [95% CI, 10.89–8373.16]; P =0.001) were associated with high FVH burden. CONCLUSIONS: FVH are prevalent in children with AIS. FVH are associated with LVO, larger infarct size, and worse outcomes. Further study is needed to determine whether FVH can be used to identify patients who would benefit most from recanalization therapies.

  PublisherDOI

• Cerebral Sinovenous Thrombosis in Children With Acute Bacterial Intracranial Infection

  Neurology · 2025-09-29 · 3 citations

  articleOpen access

  BACKGROUND AND OBJECTIVES: The epidemiology and optimal treatment strategy of cerebral sinovenous thrombosis (CSVT) in children with acute bacterial intracranial infection is largely unknown. We aimed to define the prevalence of CSVT among children with acute bacterial intracranial infection at a tertiary care pediatric hospital, to identify risk factors associated with the development of CSVT in this population, and to describe the use of anticoagulation in these children at our institution. METHODS: This was a retrospective observational cohort study of children aged 1-18 years hospitalized at a tertiary care children's hospital for acute bacterial intracranial infection between January 1, 2015, and March 31, 2023. Children with bacterial meningitis/meningoencephalitis, cerebritis, intraparenchymal abscess, subdural empyema, and/or epidural abscess who had at least 1 head imaging study were included. Cases were identified using ICD codes; medical charts were manually screened to confirm diagnoses. A multivariable logistic regression model was built to identify independent risk factors for the primary outcome of CSVT using the least absolute shrinkage and selection operator technique. RESULTS: Of 108 patients included (median age 10 years, 41% female), 33 (31%) developed CSVT. The prevalence of CSVT did not vary by year, but the absolute number of hospitalizations for acute bacterial intracranial infection rose during the study period, particularly after 2020. Presenting neurologic signs/symptoms did not differ between those who did and did not develop CSVT. Mastoiditis (adjusted odds ratio [aOR] 12.2, 95% CI 3.1-48.5), cerebritis (aOR 4.6, 95% CI 1.5-14.5), extra-axial focal suppurative infection (aOR 10.2, 95% CI 1.7-61.6), and dehydration (aOR 3.9, 95% CI 1.0-15.1) were each independently associated with CSVT. Seventy-three percent of children with CSVT (24/33) received anticoagulation (median duration 91 days) with no major bleeding events. All children with CSVT had at least partial thrombus resolution; 60% (20/33) had complete resolution. DISCUSSION: CSVT is common in children with acute bacterial intracranial infection but difficult to clinically identify. Clinicians should maintain a high index of suspicion for CSVT in this population and consider appropriate screening imaging studies, particularly in children with mastoiditis, cerebritis, extra-axial focal suppurative infection, and/or dehydration. Anticoagulation was well-tolerated in this cohort; further studies should focus on determining its safety, benefit, and ideal duration in infection-related CSVT.

  PublisherOA PDFDOI

• 905: PROGNOSTIC PREDICTIONS AFTER PEDIATRIC CARDIAC ARREST: A SINGLE-CENTER PROSPECTIVE STUDY

  Critical Care Medicine · 2025-01-01

  article
  PublisherDOI

• Infection in Childhood Arterial Ischemic Stroke: Metagenomic Next-Generation Sequencing Results of the VIPS II Study

  Stroke · 2025-05-01 · 1 citations

  articleOpen access

  BACKGROUND: Acute respiratory infection transiently increases risk for childhood arterial ischemic stroke (AIS). We hypothesize that this paradox of a common exposure linked to a rare outcome could be explained by either (1) the infection hypothesis: unusual or multiple pathogens or (2) the host response hypothesis: heterogeneity in the inflammatory response to infection. We leverage metagenomic next-generation sequencing (mNGS), a comprehensive microbial detection tool, to test the first hypothesis. METHODS: The VIPS II study (Vascular Effects of Infection in Pediatric Stroke II) prospectively enrolled children with AIS at 22 international sites over 5 years (December 2016 to January 2022). Sites measured prestroke clinical infection via standardized parental interviews and chart abstraction. To assess more broadly the background spectrum of pathogens, a central research laboratory performed mNGS on plasma and oropharyngeal swabs collected within 72 hours of stroke. mNGS was also performed on biological samples from stroke-free children (June 2017 to January 2022), both without (well) and with (ill) documentation of clinical infection. RESULTS: VIPS II enrolled 205 patients with AIS, 95 stroke-free well children, and 47 stroke-free ill children. Clinical infection, most commonly upper respiratory tract infection, was detected in 81 of 205 (40%) of patients. Both plasma and oropharyngeal swab mNGS data were available for 190 of 205 patients with AIS, 91 of 95 stroke-free well children, and 27 of 47 stroke-free ill children. mNGS detected viruses in 27 of 190 (14%) patients with AIS, 9 of 91 stroke-free well children (10%), and 9 of 27 (33%) stroke-free ill children. Most were common upper respiratory viruses. Coinfections were rare. Similar viruses were found in patients with AIS and stroke-free children. CONCLUSIONS: mNGS detected a variety of common childhood viruses in both patients with AIS and stroke-free children, suggesting that the type of infection does not explain AIS susceptibility. Rather, the alternative hypothesis regarding an unusual host immune response to common infections in the pathogenicity of AIS should be further explored.

  PublisherOA PDFDOI

• Ipsilesional Upper Extremity Impairments Increase with Severity of Contralesional Paresis in Children Following Perinatal Stroke

  SSRN Electronic Journal · 2025-01-01

  preprintOpen access
  PublisherDOI

• Changing Management of Focal Cerebral Arteriopathy of Childhood From 2010 to 2022

  Stroke · 2025-05-12 · 2 citations

  article

  BACKGROUND: The most common cause of arterial ischemic stroke in healthy children, focal cerebral arteriopathy (FCA), can progress rapidly over days with worsening brain injury. A 2017 retrospective Swiss study of corticosteroid treatment for FCA changed practice. To assess its impact, we compared the FCA cohorts from the 2 VIPS (Vascular Effects of Infection in Pediatric Stroke) prospective cohort studies. METHODS: The VIPS II study prospectively enrolled 205 children (29 days to 18 years) with arterial ischemic stroke at 22 centers, December 2016 to January 2022. The local team measured 12-month outcomes using the pediatric stroke outcome measure. A neuroradiologist and pediatric vascular neurologist independently reviewed all clinically obtained imaging and clinical data to classify the cause of arterial ischemic stroke. The neuroradiologist measured the FCA Severity Score on vascular imaging performed at any time poststroke. We compared the VIPS II FCA cohort to the previously published FCA cohort from VIPS I (2010–2014; 37 centers). RESULTS: Of 75 children with definite arteriopathy enrolled in VIPS II, 32 (43%) had FCA, compared with 41 of 127 (32%) of definite arteriopathy cases in VIPS I. The median age was 11.3 years (56% male) in VIPS I and 11.4 years (55%) in VIPS II. Treatment with intravenous corticosteroids increased from 2 of 41 (5%) of FCA patients in VIPS I to 18 of 32 (56%) in VIPS II. The VIPS II FCA cases were more severe at baseline (median FCA Severity Score 6 versus 4; P =0.006). There were no significant differences in either the change in FCA Severity Score (baseline to maximum) or the 12-month neurological outcomes. CONCLUSIONS: Treatment of FCA with corticosteroids increased dramatically between the VIPS I and VIPS II studies. VIPS II cases were more severe at baseline, but we observed no significant difference in disease progression or neurological outcomes. Given the low level of evidence supporting corticosteroid therapy, pediatric stroke centers should enroll FCA patients into ongoing FCA corticosteroid treatment trials. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT04873583 and NCT06040255.

  PublisherDOI

• Added value of perfusion MRI in neonatal arterial ischemic stroke for delineation of biomarker and prediction of remote seizure

  Proceedings on CD-ROM - International Society for Magnetic Resonance in Medicine. Scientific Meeting and Exhibition/Proceedings of the International Society for Magnetic Resonance in Medicine, Scientific Meeting and Exhibition · 2025-09-16

  article

  Motivation: Neonatal arterial ischemic stroke (NAIS) could lead to childhood epilepsy. It is critical to accurately predict remote seizures after NAIS diagnosis by adding understudied brain perfusion measures. Goal(s): To leverage multimodal MRI biomarkers to accurately predict remote seizures after investigating diffusion and perfusion MRI patterns in NAIS patients. Approach: Baseline diffusion and perfusion MRI scans acquired at initial presentation were analyzed to build an ensemble model for remote seizure prediction. Results: Unlike hypoperfusion pattern in adult brain stroke, predominant cases of hyperperfusion were identified in the NAIS population. Integrated optimized multimodal MRI-derived biomarkers effectively predict remote seizures. Impact: This study enhances understanding of NAIS by revealing unique perfusion characteristics and developing a predictive model for remote seizure after NAIS. It supports personalized interventions, potentially improving long-term outcomes and guiding future research on NAIS management and outcomes.

  PublisherDOI

• Trends in HU utilization and cerebrovascular outcomes before and after publication of the 2014 National Heart, Lung, and Blood Institute sickle cell disease guidelines

  Pediatric Hematology and Oncology · 2025-12-13

  articleOpen access

  followed at a single center before and after guideline publication. CVD was defined as the first of abnormal transcranial Doppler ultrasound, silent cerebral infarct, steno-occlusive vasculopathy, or arterial ischemic stroke. Among 530 patients with SCD, hydroxyurea prescriptions rose post-guideline, with lower age at initiation. CVD was lower post-guideline (2.2/100py) versus pre-guideline (4.4/100py). However, MRI screening also decreased post-guideline, leading to lower CVD detection. Results suggest decreased CVD, including silent cerebral infarcts, in the era of early hydroxyurea use; further analyses addressing age at hydroxyurea initiation and relevant confounders are needed to confirm whether earlier hydroxyurea initiation improves protection against CVD.

  PublisherOA PDFDOI

• Trends in HU Utilization and Cerebrovascular Outcomes Before and After Publication of the 2014 National Heart, Lung, and Blood Institute Sickle Cell Disease Guidelines

  2025-04-24

  preprintOpen access

  The 2014 National Heart, Lung, and Blood Institute guidelines recommend hydroxyurea for patients with sickle cell disease SS/ Sb 0 (SCD) aged ≥ 9 months. The relationship between early hydroxyurea and cerebrovascular disease (CVD) is unclear. In this single-center retrospective study of 530 patients with SCD, hydroxyurea prescriptions rose post-guideline, with lower age at initiation. CVD was lower post-guideline (2.2/100py) versus pre-guideline (4.4/100py). However, MRI screening decreased post-guideline, leading to lower CVD detection. Results suggest decreased CVD, including silent cerebral infarcts, in the era of early hydroxyurea; further analyses are needed to confirm earlier hydroxyurea initiation improves protective against CVD.

  PublisherOA PDFDOI

Recent grants

• NIH Grant R01NS050488

  NIH · $1.1M · 2011

• NIH Grant K08NS001805

  NIH · $455k · 2002

Frequent coauthors

• Lauren A. Beslow

  446 shared

• Gabrielle deVeber

  Hospital for Sick Children

  419 shared

• Lori C. Jordan

  Vanderbilt University Medical Center

  370 shared

• Beth S. Slomine

  Kennedy Krieger Institute

  366 shared

• Catherine Amlie‐Lefond

  University of California, San Francisco

  350 shared

• Daniel J. Licht

  University of Pennsylvania

  333 shared

• Anthony K.C. Chan

  328 shared

• James R. Christensen

  Johns Hopkins University

  294 shared

Labs

• Rebecca N. Ichord LabPI