Place des antithrombotiques dans l’accident vasculaire cérébral de l’enfant

Secondary Prevention of Childhood Arterial Ischemic Stroke

This study aimed to know how frontline physicians in France, Belgium, and Switzerland implement guidelines regarding the secondary prevention of childhood arterial ischemic stroke and to introduce physicians' point of view on a clinical trial assessing the efficacy of aspirin as a preventive strategy. The authors conducted an online survey directed at specialists throughout dedicated networks and used a mixed method for data analysis. Overall, 63 physicians responded, and 88% prescribe aspirin when sickle cell disease, cardio-embolic stroke, and dissection of cervical arteries are excluded. Prescribing habits vary among respondents with respect to their specialty. A majority would choose placebo or a treatment given to historical controls to compare with an aspirin arm in a trial. In studied countries, there seems to be good adherence to guidelines regarding the secondary prevention of childhood stroke. A trial assessing the efficacy of aspirin could be well accepted if several factors regarding study design were taken into account.

[Diagnosis and emergency treatment of stroke in children]

The sudden occurrence of a focal neurological deficit, sometimes transitory and fluctuating, must lead to a suspicion of a stroke, including in a child. The preferred examination is magnetic resonance imaging with magnetic resonance angiography in an emergency. The sequelae of stroke are common and severe. Urgent diagnosis and adapted care can help to improve morbidity-mortality. Rehabilitation starts early and must systematically screen for cognitive or language impairment. The management of a stroke in a child must be planned for in multi-disciplinary protocols established before the patient's arrival at hospital.

Chickenpox and stroke in children: case studies and literature review

Postvaricella cerebral arteriopathy (PVCA) presents with acute haemiparesis and/or haemidistonia, caused by ischaemic lesions of internal capsule and/or basal ganglia, related to stenosis of proximal middle and/or anterior cerebral arteries. Anti-aggregant drugs are recommended to prevent thrombus expansion and recurrent stroke, but neurologic outcome is usually good regardless of the therapeutic approach.

CONCLUSION

Chickenpox should be considered in differential diagnosis of ischaemic stroke in healthy children who fit the clinical and radiological typical profile of PVCA.