ABSTRACT
Stroke in children is increasingly recognized. The incidence exceeds 8 per 100,000
per year. Important differences in stroke in newborns and children compared with adults,
as well as a paucity of clinical trials, create challenges in the diagnosis and management
of pediatric arterial ischemic stroke (AIS).
The neurological presentation of AIS can be subtle. Radiographic diagnosis of acute
AIS is also challenging because CT scan may be normal early on. Risk factors include
vascular, intravascular, and embolic disorders; frequently, there are multiple risk
factors in a given child, necessitating thorough investigations. More than 50% have
a vasculopathy including postvaricella angiopathy, dissection, moyamoya, or vasculitis.
Intravascular mechanisms are frequently present, including dehydration. Hematological
or prothrombotic conditions are also associated with AIS in children, and include
sickle cell disease and prothrombotic disorders. The latter have been identified in
from one third to one half of children with AIS, are usually acquired, and frequently
act in concert with other risk factors for stroke. The most common embolic source
is congenital heart disease, which is present in 25% of children with AIS.
Outcomes include death in 6% and neurological deficits in two thirds of children.
Given that no clinical trials have been completed in pediatric stroke to date, treatment
is empiric. Initial neuroprotective strategies aim to reduce the size of the infarct.
For older children antithrombotic agents (antiplatelet drugs and anticoagulants) are
given to reduce the 20 to 30% risk of recurrence. There are coordinated research efforts
currently being initiated, which over the next decade will result in clinical trials
in this understudied condition.
KEYWORDS
Stroke - children - vascular disorders - sickle cell disease - prothrombotic conditions
