Paediatric arterial ischemic stroke: acute management, recent advances and remaining issues (original) (raw)
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ACUTE STROKE IN CHILDREN: AN OVERVIEW
Objective: The aim of this study was to delineate the different characteristics of stroke in children and their outcome. Method: Clinically diagnosed stroke in children patients underwent general, full neurological examination and radiological investigation with evaluation of severity by pediatric National institute of health scale of stroke (NIHSS) and outcome disability by using Modified Rankin Scale for children (mRS). Results: The study was conducted on 60 patients with mean age ± standard deviation was (5.98 ± 5.65), median age 3.5 (1-18), 32 (53.3%) of them were male and 28 (46.7%) were female. Most of patients (83.3%) arrived to hospital after 12 hours from the stroke onset. Etiologically, 12 (20%) patients had congenital heart disease, 8 (13.3%) had hemorrhagic diseases, while 23 (38.3%) were cryptogenic. Ischemic stroke represent 83.3% of all patients. MRI brain imaging had better evaluation in patients with hemorrhagic stroke (2 of 6 patients (33.3%) revealed underlying pathology) rather than ischemic ones (only 2 of 44 ischemic stroke patients (4.5%) showed hemorrhagic transformation in one case and vascular anomaly in the other). Twenty (33.3%) patients had mild severity using pediatric NIHSS on admission, 35 (58.3%) were mild to moderate, 3 (5.0%) were sever and 2 (3.3%) were very sever. mRS for children after three months revealed 3 patients (5.0%) with complete recovery, 14 (23.3%) had no significant disabilities despite symptoms in clinical examination, 18 (30.0%) had slight disability, 10 (16.7%) with moderate disability, 2 (3.3%) had moderately severe disability while 13 (21.7%) patients died. There was significant weak positive correlation between severity of stroke at the onset and disability outcome three months later. Conclusion: Etiological factors in childhood are quite different from those present in adulthood. Despite a careful investigation, some causes of stroke in children remain unidentified. MRI brain imaging is modality of choice in patients with hemorrhagic stroke.
Ischemic Stroke in Infants and Children: Practical Management in Emergency
Stroke Research and Treatment, 2011
Stroke is a rare disease in children, with an estimated incidence 13/100000 and a significant impact on morbidity and mortality. Clinical presentation and risk factors, present in almost half of pediatric patients, are not the same as in adults. The diagnosis of stroke in children is often delayed because signs and symptoms can be subtle and nonspecific. History and clinical examination should exclude underlying diseases or predisposing factors. Neuroimaging is crucial in defining diagnosis. Other tests might be necessary, according to the clinical picture. We present here the most recent practical directions on how to diagnose and manage arterial stroke in children, according to different international guidelines on the subject.
Current Concepts in Pediatric Stroke
The Indian Journal of Pediatrics, 2014
Stroke is a relatively rare but rather significant cause of short-and long-term morbidity and mortality in children. It can be divided into three categories: arterial ischemic stroke (AIS), hemorrhagic stroke (HS) and cerebral sinovenous thrombosis (CSVT). This review focuses on AIS. The etiologies of pediatric AIS are diverse and different from those in adult stroke, chief among these being congenital heart disease, vasculopathies, hematological disorders and prothrombotic states. Additional factors might be related to the age group, ethnicity and geographic factors. Early recognition enables initiation of prompt therapy thereby reducing risk of further recurrence and complications.
Investigation and management of childhood stroke
Paediatrics and Child Health, 2010
It is now clear that a number of paediatric emergencies with a neurological presentation, including hemiparesis, visual loss, seizures and coma, commonly have a vascular basis which may not be obvious on CT scan. Although many children do well, as there is significant mortality as well as morbidity for childhood stroke, in addition to a high risk for recurrence, making a diagnosis in the acute phase important. Venography and arteriography (including the neck vessels if the intracranial vessels are normal) are usually indicated despite the problems i.e. contrast CTrequires a high dose of radiation while emergency MR usually requires anaesthesia and conventional arteriography carries a small risk of stroke. Surgical decompression may be life-saving in ischaemic as well as haemorrhagic stroke. It is unusual for children with anterior circulation stroke to be triaged quickly enough (<4.5 h) for thrombolysis but this may occasionally be appropriate in posterior circulation occlusion associated with coma, where the time window is longer (<12 h). Anticoagulation carries relatively low risk and may be of benefit for children with venous sinus thrombosis (acutely and when at risk subsequently) or extracranial dissection. Aspirin to attempt to reduce the recurrence risk is appropriate in the medium term for the majority of patients with arterial ischaemic stroke. Iron and B vitamin deficiencies should be excluded or treated.
Emergency Medicine International, 2011
Stroke is relatively rare in children, but can lead to significant morbidity and mortality. Understanding that children with strokes present differently than adults and often present with unique risk factors will optimize outcomes in children. Despite an increased incidence of pediatric stroke, there is often a delay in diagnosis, and cases may still remain under-or misdiagnosed. Clinical presentation will vary based on the child's age, and children will have risk factors for stroke that are less common than in adults. Management strategies in children are extrapolated primarily from adult studies, but with different considerations regarding shortterm anticoagulation and guarded recommendations regarding thrombolytics. Although most recommendations for management are extrapolated from adult populations, they still remain useful, in conjunction with pediatric-specific considerations.
Acute Childhood Arterial Ischemic and Hemorrhagic Stroke in the Emergency Department
Annals of Emergency Medicine, 2011
Little is known about the presenting features of acute ischemic and hemorrhagic stroke in children presenting to the emergency department (ED). Yet, initial clinical assessment is a key step in the management pathway of stroke. We describe the presentation in the ED of children with confirmed acute ischemic and hemorrhagic stroke subtypes.
Jornal de Pediatria, 2009
Objectives: To summarize 1) the definitions and epidemiological features of stroke in children; 2) the main risk factors that can lead to stroke in pediatrics and neonatology; 3) the main pathophysiological features involved in the genesis of brain injury in stroke; 4) the clinical manifestations and imaging diagnosis; and 5) the latest recommendations concerning the support measures, treatment, and prophylaxis of stroke in children. Sources: A review of the literature published in PubMed, EMBASE, and SciELO databases using the search terms stroke, pediatrics, and neonatology was performed, including relevant references from the chosen texts. Summary of the findings: Stroke in children are rare conditions, with incidence rates among two and eight per 100,000 children up to 14 years, and most cases show an underlying disease such as heart diseases, prothrombotic conditions, sickle-cell disease, and vascular malformations. There are no specific guidelines currently in place for the treatment of stroke in children, although central elements include support treatment, monitoring, and anticoagulation as secondary prevention in certain cases. Prognosis depends on the extent of brain damage and the underlying disease but recurrence rates are high in most cases. Conclusions: Early diagnosis of stroke in children is very important and pediatricians should be aware of the lack of specificity of the symptoms to avoid late sequelae and improve life quality.