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Stroke

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Abstract

Stroke in infants and children is a neurological emergency. Prompt diagnosis and treatment are essential to the prevention of further brain injury. There are three major categories of stroke - ischemic stroke, hemorrhagic stroke, and neonatal stroke. Arterial ischemic stroke is most commonly due to vasculopathy, thrombotic state, or metabolic disease. Vasculopathies include focal cerebral arteriopathy, arterial dissection, Moya moya syndrome, and genetic disorders causing vascular abnormalities. Thrombotic stroke is due to an underlying hypercoagulable state or thromboembolic disease. Metabolic diseases causing stroke include mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes, Fabry Disease, urea cycle disorders, and organic acidurias. Hemorrhagic stroke is almost always due to a pre-existing vascular malformation. Various diagnostic modalities are used to diagnose stroke. Computed tomography is rapid but exposes children to radiation. Magnetic resonance imaging is the modality of choice, though its use can be limited if sedation is required. Evaluation for underlying cause of stroke is guided by the stroke subtype, though in pediatric stroke, genetic causes of stroke should be carefully considered. Treatment of stroke is based largely upon adult practice, even though the etiology of stroke in childhood is not the same. Acute treatment is largely supportive and focused on secondary prevention. Multicenter studies of neonatal and childhood stroke are underway, and evidence-based diagnostic and treatment strategies are on the horizon. A comprehensive and systematic approach to pediatric stroke is a necessary component of pediatric intensive care.

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References

  1. National Center for Health Statistics. Leading causes of death and numbers of deaths, by age: United States, 1980 and 2007. www.cdc.gov/nchs/data/hus/2010/027.pdf. Accessed 31 Aug 2011.

  2. Fullerton HJ, Wu YW, Zhao S, Johnston SC. Risk of stroke in children: ethnic and gender disparities. Neurology. 2003;61(2):189–94.

    Article  PubMed  Google Scholar 

  3. Braun KP, Bulder MM, Chabrier S, et al. The course and outcome of unilateral intracranial arteriopathy in 79 children with ischaemic stroke. Brain J Neurol. 2009;132(Pt 2):544–57.

    CAS  Google Scholar 

  4. Fullerton HJ, Elkind MS, Barkovich AJ, et al. The vascular effects of infection in pediatric stroke (VIPS) study. J Child Neurol. 2011;26(9):1101–10.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Amlie-Lefond C, Bernard TJ, Sebire G, et al. Predictors of cerebral arteriopathy in children with arterial ischemic stroke: results of the International Pediatric Stroke Study. Circulation. 2009;119(10):1417–23.

    Article  PubMed  Google Scholar 

  6. Adams RJ, McKie VC, Hsu L, et al. Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med. 1998;339(1):5–11.

    Article  CAS  PubMed  Google Scholar 

  7. Benseler SM, Silverman E, Aviv RI, et al. Primary central nervous system vasculitis in children. Arthritis Rheum. 2006;54(4):1291–7.

    Article  PubMed  Google Scholar 

  8. Aviv RI, Benseler SM, Silverman ED, et al. MR imaging and angiography of primary CNS vasculitis of childhood. AJNR Am J Neuroradiol. 2006;27(1):192–9.

    CAS  PubMed  Google Scholar 

  9. Barnes C, Deveber G. Prothrombotic abnormalities in childhood ischaemic stroke. Thromb Res. 2006;118(1):67–74.

    Article  CAS  PubMed  Google Scholar 

  10. Calvert PA, Rana BS, Kydd AC, Shapiro LM. Patent foramen ovale: anatomy, outcomes, and closure. Nat Rev Cardiol. 2011;8(3):148–60.

    Article  PubMed  Google Scholar 

  11. McCandless RT, Arrington CB, Nielsen DC, Bale Jr JF, Minich LL. Patent foramen ovale in children with migraine headaches. J Pediatr. 2011;159(2):243–7. e241.

    Article  PubMed  Google Scholar 

  12. Ramaswamy V, Mehta V, Bauman M, Richer L, Massicotte P, Yager JY. Decompressive hemicraniectomy in children with severe ischemic stroke and life-threatening cerebral edema. J Child Neurol. 2008;23(8):889–94.

    Article  PubMed  Google Scholar 

  13. Goldenberg NA, Bernard TJ, Fullerton HJ, Gordon A, de Veber G. Antithrombotic treatments, outcomes, and prognostic factors in acute childhood-onset arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol. 2009;8(12):1120–7.

    Article  CAS  PubMed  Google Scholar 

  14. Amlie-Lefond C, de Veber G, Chan AK, et al. Use of alteplase in childhood arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol. 2009;8(6):530–6.

    Article  PubMed  Google Scholar 

  15. Statler KD, Dong L, Nielsen DM, Bratton SL. Pediatric stroke: clinical characteristics, acute care utilization patterns, and mortality. Childs Nerv Syst. 2011;27(4):565–73.

    Article  PubMed  Google Scholar 

  16. Fullerton HJ, Wu YW, Sidney S, Johnston SC. Risk of recurrent childhood arterial ischemic stroke in a population-based cohort: the importance of cerebrovascular imaging. Pediatrics. 2007;119(3):495–501.

    Article  PubMed  Google Scholar 

  17. Fullerton HJ, Achrol AS, Johnston SC, et al. Long-term hemorrhage risk in children versus adults with brain arteriovenous malformations. Stroke. 2005;36(10):2099–104.

    Article  PubMed  Google Scholar 

  18. Jordan LC, Johnston SC, Wu YW, Sidney S, Fullerton HJ. The importance of cerebral aneurysms in childhood hemorrhagic stroke: a population-based study. Stroke. 2009;40(2):400–5.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Roach ES, Golomb MR, Adams R, et al. Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke. 2008;39(9):2644–91.

    Article  PubMed  Google Scholar 

  20. Mullins ME, Lev MH, Bove P, et al. Comparison of image quality between conventional and low-dose nonenhanced head CT. AJNR Am J Neuroradiol. 2004;25(4):533–8.

    PubMed  Google Scholar 

  21. Hubail Z, Lemler M, Ramaciotti C, Moore J, Ikemba C. Diagnosing a patent foramen ovale in children: is transesophageal echocardiography necessary? Stroke. 2011;42(1):98–101.

    Article  PubMed  Google Scholar 

  22. Belvis R, Leta RG, Marti-Fabregas J, et al. Almost perfect concordance between simultaneous transcranial Doppler and transesophageal echocardiography in the quantification of right-to-left shunts. J Neuroimaging. 2006;16(2):133–8.

    Article  PubMed  Google Scholar 

  23. Amlie-Lefond C, Chan AK, Kirton A, et al. Thrombolysis in acute childhood stroke: design and challenges of the thrombolysis in pediatric stroke clinical trial. Neuroepidemiology. 2009;32(4):279–86.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Pediatric Neurology, Primary Children’s Medical Center, University of Utah, 100 N. Medical Drive, Salt Lake City, UT, 84113, USA

    Brandon A. Zielinski MD, PhD

  2. Division of Pediatric Neurology, Granger Medical Clinic, 12391 South 4000 West, Riverton, UT, 84065, USA

    Denise Morita MD

Authors
  1. Brandon A. Zielinski MD, PhD
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  2. Denise Morita MD
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Corresponding author

Correspondence to Denise Morita MD .

Editor information

Editors and Affiliations

  1. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Derek S. Wheeler

  2. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Hector R. Wong

  3. Pediatric Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA

    Thomas P. Shanley

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© 2014 Springer-Verlag London

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Zielinski, B.A., Morita, D. (2014). Stroke. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6356-5_36

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  • DOI: https://doi.org/10.1007/978-1-4471-6356-5_36

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6355-8

  • Online ISBN: 978-1-4471-6356-5

  • eBook Packages: MedicineMedicine (R0)

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