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Arterial Ischemic Stroke in Childhood

  • Pediatrics in South America (L Landry and WB de Carvalho, Section Editors)
  • Published:
Current Treatment Options in Pediatrics Aims and scope Submit manuscript

Abstract

Purpose of review

Arterial ischemic stroke in children is a severe disorder with significant morbidity and mortality. Urgent diagnosis is mandatory in order to save lives or minimize neurological sequelae. However, recognition of stroke in children is more difficult than in adults. Barriers such as low suspicion, diverse risk factors, difficulties performing neuroimages, and a lack of protocols for diagnosis and treatment make stroke management in children a challenge. This article aims to review the approach to arterial stroke in children.

Recent findings

Recently, more focus has been placed in the development of comprehensive stroke centers for treatment of stroke in children. Shortening time for diagnosis allows initiating a prompt and successful hyperacute treatment. Neuroprotection must be initiated before diagnosis confirmation. As in adult patients, widening the thrombolytic treatment time window and optimizing secondary stroke prevention are main points to develop. Early decompressive hemicraniectomy in children with malignant infarct should be considered.

Summary

A multidisciplinary team is necessary for the diagnosis and treatment of children with brain attack. A particular “stroke code” must be established in each institution for stroke management and evidence-based guidelines should be developed.

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Abbreviations

AIS:

arterial ischemic stroke

CHD:

congenital heart disease

AHD:

acquired heart disease

SCD:

sickle cell disease

MTHFR:

methylene tetrahydrofolate

ICA:

internal carotid artery

VA:

vertebral artery

TIA:

transient ischemic attack

CT:

computes tomography

MRI:

magnetic resonance imaging

VZV:

varicella zoster virus

ACA:

anterior cerebral artery

MCA:

middle cerebral artery

TCA:

transient cerebral arteriopathy

RPLS:

reversible posterior leukoencephalopathy syndrome

t-PA:

tissue plasminogen activator

ER:

endovascular revascularization

DWI:

diffusion weighted imaging

pcASL:

pseudocontinuous arterial spin labeling

SWI:

susceptibility-weighted imaging

T2*-GRE:

T2 gradient echo images

VWI:

vessel wall images

NIHSS:

National Institutes of Health Stroke Scale

PedNIHSS:

Pediatric National Institutes of Health Stroke Scale

AHA:

American Heart Association

ASA:

American Stroke Association

SBP:

systemic blood pressure

MT:

mechanical thrombectomy

LAO:

large artery occlusion

TIPS:

Thrombolysis in Pediatric Stroke

ICP:

intra cranial pressure

TCD:

transcranial Doppler ultrasonography

ACCP:

American College of Chest Physicians

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Authors and Affiliations

  1. Pediatric Medical Surgical Intensive Care Unit, Hospital de Pediatría J.P. Garrahan, Combate de los Pozos 1881, (C1245 AAM) C.A.B.A, Buenos Aires, Argentina

    Monica Ana R. Centeno MD

  2. Department of Neurology, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina

    Maria Celeste Buompadre MD

  3. Interventional Neuroradiology Unit, Interventional Area, Garrahan Children’s Hospital, Buenos Aires, Argentina

    Flavio Requejo MD

  4. Magnetic Resonance Imaging Unit, Imaging Area, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina

    Carlos Rugilo MD

  5. Department of Hematology and Oncology, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina

    Carolina Cervio MD & Gabriela Sciuccati MD

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  1. Monica Ana R. Centeno MD
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  2. Maria Celeste Buompadre MD
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  3. Flavio Requejo MD
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  4. Carlos Rugilo MD
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Correspondence to Monica Ana R. Centeno MD.

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Monica Ana R. Centeno declares that she has no conflict of interest. Maria Celeste Buompadre declares that she has no conflict of interest. Flavio Requejo declares that he has no conflict of interest. Carlos Rugilo declares that he has no conflict of interest. Carolina Cervio declares that she has no conflict of interest. Gabriela Sciuccati declares that she has no conflict of interest.

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Centeno, M.A.R., Buompadre, M.C., Requejo, F. et al. Arterial Ischemic Stroke in Childhood. Curr Treat Options Peds 5, 380–396 (2019). https://doi.org/10.1007/s40746-019-00174-3

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