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Semin Thromb Hemost 2011; 37(7): 786-793
DOI: 10.1055/s-0031-1297169
© Thieme Medical Publishers

Childhood Arterial Ischemic Stroke: A Review of Etiologies, Antithrombotic Treatments, Prognostic Factors, and Priorities for Future Research

Courtney A. Lyle1 , 2 , Timothy J. Bernard3 , 4 , 5 , Neil A. Goldenberg3 , 5 , 6
  • 1Division of Hematology/Oncology, Department of Pediatrics, University of California
  • 2Rady Children's Hospital, San Diego, California, University of Colorado, Aurora, Colorado
  • 3Department of Pediatrics, University of Colorado, Aurora, Colorado
  • 4Sections of Child Neurology, University of Colorado, Aurora, Colorado
  • 5Department of Hematology/Oncology/Bone Marrow Transplantation and the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, Aurora, Colorado
  • 6Department of Medicine, University of Colorado, Aurora, Colorado, University of Colorado, Aurora, Colorado
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Publication History

Publication Date:
20 December 2011 (online)

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ABSTRACT

Childhood arterial ischemic stroke (AIS) is a rare, but serious, medical condition, which is fatal in approximately 3% and associated with both acute and long-term neurologic impairment in over 70% of cases. Common etiologies include sickle cell disease, congenital heart disease, arterial dissection, prothrombotic conditions, and preceding viral infections; however, one in four cases is considered idiopathic. To date, no randomized controlled clinical trials (RCTs) have been conducted to establish evidence for current therapeutic strategies outside of sickle cell disease, thus, treatment strategies are largely shaped by consensus-based guidelines, in which, beyond the acute period, aspirin is the mainstay of therapy and anticoagulation is reserved for select circumstances. In recent years, evidence on prognostic factors has accumulated, helping to inform the future design of prognostically stratified RCTs. In this narrative review, we discuss the current understanding of etiologies, consensus-based treatment recommendations, contemporary treatment data, and prognostic factors in childhood AIS. We also identify priorities for future research.

KEYWORDS

Childhood arterial ischemic stroke - pediatric stroke

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Courtney A. LyleM.D. 

Rady Children's Hospital, 3020 Children's Way MC 5035

San Diego, CA 92123

Email: calyle@rchsd.org