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Arterial ischemic stroke in non-neonate children: Diagnostic and therapeutic specificities. Rev Neurol (Paris) 2020; 176:20-29. [DOI: 10.1016/j.neurol.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 12/12/2022]
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2
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Siniscalchi A, De Sarro G, Pacifici R, Pisani E, Sanguigni S, Gallelli L. Thrombolytic Therapy in Cocaine Users with Ischemic Stroke: A Review of Current Practice. PSYCHOPHARMACOLOGY BULLETIN 2019; 49:70-79. [PMID: 30858640 PMCID: PMC6386426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Alteplase is the main pharmacological treatment available for intravenous thrombolysis in patients with acute ischemic stroke. Endovascular treatment alone or add-on to intravenous thrombolysis is a valid approach in acute ischemic stroke with cerebral large vessel disease. The most common serious adverse reaction related to alteplase is the development of spontaneous intracerebral hemorrhage and the presence of cerebral small vessel disease may increase this risk, particularly in cocaine users, even if only few data have been published on this topic. Here we reviewed in cocaine users with acute ischemic stroke the efficacy and safety of thrombolytic therapy.
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Affiliation(s)
- Antonio Siniscalchi
- Siniscalchi, MD, Pisani, Department of Neurology, "Annunziata" Hospital, Cosenza, Italy. De Sarro, Gallelli, Department of Health Science, School of Medicine, University of Catanzaro Clinical Pharmacology and Pharmacovigilance Unit, Mater Domini University Hospital, Catanzaro, Italy. Pacifici, National Centre on Addiction and Doping, Istituto Superiore di Sanita, V.le Regina Elena 299, Rome. Italy. Sanguigni, Department of Neurology, Madonna del Soccorso Hospital, S Benedetto del Tronto, Italy
| | - Giovambattista De Sarro
- Siniscalchi, MD, Pisani, Department of Neurology, "Annunziata" Hospital, Cosenza, Italy. De Sarro, Gallelli, Department of Health Science, School of Medicine, University of Catanzaro Clinical Pharmacology and Pharmacovigilance Unit, Mater Domini University Hospital, Catanzaro, Italy. Pacifici, National Centre on Addiction and Doping, Istituto Superiore di Sanita, V.le Regina Elena 299, Rome. Italy. Sanguigni, Department of Neurology, Madonna del Soccorso Hospital, S Benedetto del Tronto, Italy
| | - Roberta Pacifici
- Siniscalchi, MD, Pisani, Department of Neurology, "Annunziata" Hospital, Cosenza, Italy. De Sarro, Gallelli, Department of Health Science, School of Medicine, University of Catanzaro Clinical Pharmacology and Pharmacovigilance Unit, Mater Domini University Hospital, Catanzaro, Italy. Pacifici, National Centre on Addiction and Doping, Istituto Superiore di Sanita, V.le Regina Elena 299, Rome. Italy. Sanguigni, Department of Neurology, Madonna del Soccorso Hospital, S Benedetto del Tronto, Italy
| | - Ermanno Pisani
- Siniscalchi, MD, Pisani, Department of Neurology, "Annunziata" Hospital, Cosenza, Italy. De Sarro, Gallelli, Department of Health Science, School of Medicine, University of Catanzaro Clinical Pharmacology and Pharmacovigilance Unit, Mater Domini University Hospital, Catanzaro, Italy. Pacifici, National Centre on Addiction and Doping, Istituto Superiore di Sanita, V.le Regina Elena 299, Rome. Italy. Sanguigni, Department of Neurology, Madonna del Soccorso Hospital, S Benedetto del Tronto, Italy
| | - Sandro Sanguigni
- Siniscalchi, MD, Pisani, Department of Neurology, "Annunziata" Hospital, Cosenza, Italy. De Sarro, Gallelli, Department of Health Science, School of Medicine, University of Catanzaro Clinical Pharmacology and Pharmacovigilance Unit, Mater Domini University Hospital, Catanzaro, Italy. Pacifici, National Centre on Addiction and Doping, Istituto Superiore di Sanita, V.le Regina Elena 299, Rome. Italy. Sanguigni, Department of Neurology, Madonna del Soccorso Hospital, S Benedetto del Tronto, Italy
| | - Luca Gallelli
- Siniscalchi, MD, Pisani, Department of Neurology, "Annunziata" Hospital, Cosenza, Italy. De Sarro, Gallelli, Department of Health Science, School of Medicine, University of Catanzaro Clinical Pharmacology and Pharmacovigilance Unit, Mater Domini University Hospital, Catanzaro, Italy. Pacifici, National Centre on Addiction and Doping, Istituto Superiore di Sanita, V.le Regina Elena 299, Rome. Italy. Sanguigni, Department of Neurology, Madonna del Soccorso Hospital, S Benedetto del Tronto, Italy
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Kulhari A, Dorn E, Pace J, Alambyan V, Chen S, Wu OC, Rizvi M, Hammond A, Ramos-Estebanez C. Acute Ischemic Pediatric Stroke Management: An Extended Window for Mechanical Thrombectomy? Front Neurol 2017; 8:634. [PMID: 29238322 PMCID: PMC5712569 DOI: 10.3389/fneur.2017.00634] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/13/2017] [Indexed: 11/26/2022] Open
Abstract
Ischemic stroke is a rare condition to afflict the pediatric population. Congenital cardiomyopathy represents one of several possible etiologies in children. We report a 9-year-old boy who developed right middle cerebral artery stroke secondary to primary restrictive cardiomyopathy. In the absence of pediatric guidelines, the child met adult criteria for mechanical thrombectomy given the small core infarct and large penumbra. The literature suggests children may benefit from mechanical thrombectomy in carefully selected cases. Our patient exemplifies specific circumstances in which acute stroke therapy with thrombolysis and thrombectomy may be safe.
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Affiliation(s)
- Ashish Kulhari
- Department of Neurology, Neurological Institute, University Hospitals, Cleveland, OH, United States.,Department of Neurological Surgery, Neurological Institute, University Hospitals, Cleveland, OH, United States
| | - Elizabeth Dorn
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH, United States
| | - Jonathan Pace
- Department of Neurology, Neurological Institute, University Hospitals, Cleveland, OH, United States.,Department of Neurological Surgery, Neurological Institute, University Hospitals, Cleveland, OH, United States
| | - Vilakshan Alambyan
- Department of Neurology, Neurological Institute, University Hospitals, Cleveland, OH, United States.,Department of Neurological Surgery, Neurological Institute, University Hospitals, Cleveland, OH, United States
| | - Stephanie Chen
- Department of Physiology, Case Western Reserve University, Cleveland, OH, United States
| | - Osmond C Wu
- Department of Neurology, Neurological Institute, University Hospitals, Cleveland, OH, United States.,Department of Neurological Surgery, Neurological Institute, University Hospitals, Cleveland, OH, United States
| | - Macym Rizvi
- Department of Neurology, Neurological Institute, University Hospitals, Cleveland, OH, United States.,Department of Neurological Surgery, Neurological Institute, University Hospitals, Cleveland, OH, United States
| | - Anthony Hammond
- Department of Emergency Medicine, University Hospitals, Cleveland, OH, United States
| | - Ciro Ramos-Estebanez
- Department of Neurology, Neurological Institute, University Hospitals, Cleveland, OH, United States.,Department of Neurological Surgery, Neurological Institute, University Hospitals, Cleveland, OH, United States
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Klucka J, Stourac P, Stoudek R, Toukalkova M, Harazim H, Kosinova M, Stouracova A, Mrlian A, Suk P, Malaska J. Ischemic stroke in paediatrics - narrative review of the literature and two cases. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017; 161:24-30. [DOI: 10.5507/bp.2016.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/11/2016] [Indexed: 12/30/2022] Open
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Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, Khalessi AA, Levy EI, Palesch YY, Prabhakaran S, Saposnik G, Saver JL, Smith EE. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke. Stroke 2016; 47:581-641. [DOI: 10.1161/str.0000000000000086] [Citation(s) in RCA: 442] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose—
To critically review and evaluate the science behind individual eligibility criteria (indication/inclusion and contraindications/exclusion criteria) for intravenous recombinant tissue-type plasminogen activator (alteplase) treatment in acute ischemic stroke. This will allow us to better inform stroke providers of quantitative and qualitative risks associated with alteplase administration under selected commonly and uncommonly encountered clinical circumstances and to identify future research priorities concerning these eligibility criteria, which could potentially expand the safe and judicious use of alteplase and improve outcomes after stroke.
Methods—
Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee and the American Heart Association’s Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge and, when appropriate, formulated recommendations using standard American Heart Association criteria. All members of the writing group had the opportunity to comment on and approved the final version of this document. The document underwent extensive American Heart Association internal peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee.
Results—
After a review of the current literature, it was clearly evident that the levels of evidence supporting individual exclusion criteria for intravenous alteplase vary widely. Several exclusionary criteria have already undergone extensive scientific study such as the clear benefit of alteplase treatment in elderly stroke patients, those with severe stroke, those with diabetes mellitus and hyperglycemia, and those with minor early ischemic changes evident on computed tomography. Some exclusions such as recent intracranial surgery are likely based on common sense and sound judgment and are unlikely to ever be subjected to a randomized, clinical trial to evaluate safety. Most other contraindications or warnings range somewhere in between. However, the differential impact of each exclusion criterion varies not only with the evidence base behind it but also with the frequency of the exclusion within the stroke population, the probability of coexistence of multiple exclusion factors in a single patient, and the variation in practice among treating clinicians.
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Nasr DM, Biller J, Rabinstein AA. Use and in-hospital outcomes of recombinant tissue plasminogen activator in pediatric arterial ischemic stroke patients. Pediatr Neurol 2014; 51:624-31. [PMID: 25194722 DOI: 10.1016/j.pediatrneurol.2014.07.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 07/19/2014] [Accepted: 07/22/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Outcomes in pediatric stroke are poorly understood. We sought to determine trends in the use of recombinant tissue plasminogen activator (rt-PA), treatment outcomes, and predictors of mortality for pediatric patients with acute ischemic stroke by using the Nationwide Inpatient Sample. METHODS Using Nationwide Inpatient Sample data from 2001 to 2010, we identified pediatric patients (age 30 days to 18 years) with the primary diagnosis of arterial ischemic stroke. We studied trends of use of intravenous rt-PA and outcomes after thrombolysis. We also analyzed the associations of demographic factors, comorbidities, and complications of arterial ischemic stroke with in-hospital mortality. RESULTS This study included 7044 patients. In-hospital mortality was 4.7%. The comorbidities associated with the greatest rates of in-hospital mortality were mitochondrial disorders (19.5%, P < 0.0001) and hypercoagulable states (11.4%, P < 0.0001). The main complications associated with increased mortality were intracerebral hemorrhage (19.9%, P < 0.0001), sepsis (13.2%, P < 0.0001), and pneumonia (9.3%, P = 0.0007). The rate of rt-PA use was 1.4% (99 patients). rt-PA use increased from 0.9% of patients in 2001-2005 to 2.0% in 2006-2010 (P < 0.0001). Among patients who received rt-PA, the rate of intracerebral hemorrhage was low and without fatalities; however, there was an increased discharge-to-long-term-facilities rate in the rt-PA group (50.8% versus 12.1%, P < 0.0001). CONCLUSION Arterial ischemic stroke in the pediatric population is associated with a greater rate of mortality when related to mitochondrial diseases or hypercoagulability. rt-PA use is increasing in pediatric patients with arterial ischemic stroke. Pediatric patients receiving rt-PA have a low risk of fatal hemorrhage. Although patients receiving rt-PA have a morbidity rate, these individuals may have a worse stroke severity.
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Affiliation(s)
- Deena M Nasr
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.
| | - Jose Biller
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
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Rahme R, Jimenez L, Bashir U, Adeoye OM, Abruzzo TA, Ringer AJ, Kissela BM, Khoury J, Moomaw CJ, Sucharew H, Ferioli S, Flaherty ML, Woo D, Khatri P, Alwell K, Kleindorfer D. Malignant MCA territory infarction in the pediatric population: subgroup analysis of the Greater Cincinnati/Northern Kentucky Stroke Study. Childs Nerv Syst 2013; 29:99-103. [PMID: 22914922 PMCID: PMC3690124 DOI: 10.1007/s00381-012-1894-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 08/07/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE Malignant middle cerebral artery (MCA) infarctions are thought to be rare in children. In a recent hospital-based study, only 1.3 % of pediatric ischemic strokes were malignant MCA infarctions. However, population-based rates have not been published. We performed subgroup analysis of a population-based study to determine the rate of malignant MCA infarctions in children. METHODS In 2005 and 2010, all ischemic stroke-related emergency visits and hospital admissions among the 1.3 million residents of the five-county Greater Cincinnati/Northern Kentucky area were ascertained. Cases that occurred in patients 18 years and younger were reviewed in detail, and corresponding clinical and neuroimaging findings were recorded. Infarctions were considered malignant if they involved 50 % or more of the MCA territory and resulted in cerebral edema and mass effect. RESULTS In 2005, eight pediatric ischemic strokes occurred in the study population, none of which were malignant infarctions. In 2010, there were also eight ischemic strokes. Of these, two malignant MCA infarctions were identified: (1) a 7-year-old boy who underwent hemicraniectomy and survived with moderate disability at 30 days and (2) a 17-year-old girl with significant prestroke disability who was not offered hemicraniectomy and died following withdrawal of care. Thus, among 16 children over 2 years, there were two malignant MCA infarctions (12.5 %, 95 % CI 0-29). CONCLUSIONS Malignant MCA infarctions in children may not be as rare as previously thought. Given the significant survival and functional outcome benefit conferred by hemicraniectomy in adults, future studies focusing on its potential role in pediatric patients are warranted.
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Affiliation(s)
- Ralph Rahme
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | - Lincoln Jimenez
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | - Umair Bashir
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | - Opeolu M. Adeoye
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | - Todd A. Abruzzo
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | - Andrew J. Ringer
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | - Brett M. Kissela
- Department of Neurology, University of Cincinnati, 260 Stetson Street, Suite 2300, Cincinnati, OH 45219, USA
| | - Jane Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Charles J. Moomaw
- Department of Neurology, University of Cincinnati, 260 Stetson Street, Suite 2300, Cincinnati, OH 45219, USA
| | - Heidi Sucharew
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Simona Ferioli
- Department of Neurology, University of Cincinnati, 260 Stetson Street, Suite 2300, Cincinnati, OH 45219, USA
| | - Matthew L. Flaherty
- Department of Neurology, University of Cincinnati, 260 Stetson Street, Suite 2300, Cincinnati, OH 45219, USA
| | - Daniel Woo
- Department of Neurology, University of Cincinnati, 260 Stetson Street, Suite 2300, Cincinnati, OH 45219, USA
| | - Pooja Khatri
- Department of Neurology, University of Cincinnati, 260 Stetson Street, Suite 2300, Cincinnati, OH 45219, USA
| | - Kathleen Alwell
- Department of Neurology, University of Cincinnati, 260 Stetson Street, Suite 2300, Cincinnati, OH 45219, USA
| | - Dawn Kleindorfer
- Department of Neurology, University of Cincinnati, 260 Stetson Street, Suite 2300, Cincinnati, OH 45219, USA
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Brumback RA. Neurobiology of disease in children: a decade of successful symposia and a robust partnership with the Journal of Child Neurology. J Child Neurol 2011; 26:1475-9. [PMID: 22114242 DOI: 10.1177/0883073811426934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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