Ischemic stroke in infants and children: practical management in emergency

Placement of Endovascular Stent for Reperfusion of Cerebral Infarct After Pediatric Traumatic Internal Carotid Artery Dissection

Background

Traumatic intracranial ICA dissections are not commonly seen in children. Dissection resulting in perfusion deficit warrants intervention. Here we encountered a patient who experienced traumatic ICA dissection, treated by endovascular stenting.

Methods

A 10-year-old female presented with aphasia and right sided weakness following trauma. Imaging showed deficit in the left MCA territory without core. Further imaging showed dissection of the left supraclinoid ICA, confirmed by digital subtraction angiography.

Results

A Neuroform Atlas stent was placed without complication. All dysarthria and weakness had resolved on follow-up 5 months post-stenting.

Conclusions

Acute stroke symptoms in children can result in lasting deficits if not treated quickly. Medical management is regarded to be first line, depending on presentation. Endovascular stenting may provide a promising means to treat pediatric ICA dissections involving perfusion deficits and mitigate permanent ischemic changes.

Acute StrokeTreatment in Children: Are Adult Guidelines Applicable?

Purpose of this Review

This article provides an overview into acute treatments in stroke which are widely studied and available for adults and their applicability in the pediatric population.

Recent Findings

Arterial ischemic stroke is an important cause of morbidity and mortality in the pediatric population. Neurological deficits and etiologies are age-dependent and more challenging to diagnose than in the adult population. Advancements in imaging and treatment modalities including increased treatment windows in acute stroke have led to improvement in the diagnosis and management of pediatric arterial ischemic disease. Accordingly, hyperacute treatments, such as endovascular therapy, are becoming increasingly available in an attempt to improve outcomes in children.

Summary

Significant scientific and technological advances have transformed the hyperacute treatment of stroke in the recent years, allowing for improvement in the diagnosis and treatment of cerebrovascular pathologies in children. Optimization in the approach, and validation of existing stroke pathways/protocols is expected to further advance acute stroke therapy in pediatric patient care. Given that the lifelong individual, family, and societal burden of acute stroke is likely to be greater than in adults because infants and children surviving stroke live more years with disability, we must be knowledgeable about this pathology and the medical and therapeutic options available for this unique population as detailed in this review.

Incidence and Etiology of Stroke among Hospitalized Children: A Case-Series Study

OBJECTIVES

Stroke is a sudden blockage or rupture of brain vessels resulting neural defect or impairment. We aimed to investigate the incidence and causes of stroke in hospitalized children (Tehran-Iran, 2008-2013).

MATERIALS & METHODS

This case series study was carried out in pediatric ward of tertiary care Vali-Asr Hospital, Imam Khomeini Hospitals Complex (Tehran- Iran) from 2008 to 2013. One month to 15 yr old admitted children due to stroke were enrolled into this case series study. Diagnosis was confirmed with brain imaging. Participants' demographic data, potential risk factors and neuroimaging findings were obtained from Hospital Reporting System. Recorded data were studied and considered regarding the incidence of stroke and its causes. Indeed we investigated cardiological causes as well as different items related to hematological disorders.

RESULTS

Of 20000 admitted subjects in Imam Hospital during 5 yr, stroke was diagnosed in 15 cases. The incidence among the population study was 0.75 per 100000 children. Stroke was more frequent in males than females ( 1.14 1 ). The most common age of stroke was 4-6 yr and the mean age of stroke was 58.8 months equal to 4.9 year. The most frequent stroke was hemorrhagic stroke (26%), followed by vascular (20%) and coagulopathy disorders (20%).

CONCLUSION

The incidence of stroke in children was 0.75 per 100000. Hemorrhagic stroke due to major trauma, coagulopathy and vasculopathy were observed as most frequent causes that necessitate implementing some strategies for prevention, earlier diagnosis, and treatment.

Paediatric arterial ischemic stroke: acute management, recent advances and remaining issues

Stroke is a rare disease in childhood with an estimated incidence of 1-6/100.000. It has an increasingly recognised impact on child mortality along with its outcomes and effects on quality of life of patients and their families. Clinical presentation and risk factors of paediatric stroke are different to those of adults therefore it can be considered as an independent nosological entity. The relative rarity, the age-related peculiarities and the variety of manifested symptoms makes the diagnosis of paediatric stroke extremely difficult and often delayed. History and clinical examination should investigate underlying diseases or predisposing factors and should take into account the potential territoriality of neurological deficits and the spectrum of differential diagnosis of acute neurological accidents in childhood. Neuroimaging (in particular diffusion weighted magnetic resonance) is the keystone for diagnosis of paediatric stroke and other investigations might be considered according to the clinical condition. Despite substantial advances in paediatric stroke research and clinical care, many unanswered questions remain concerning both its acute treatment and its secondary prevention and rehabilitation so that treatment recommendations are mainly extrapolated from studies on adult population. We have tried to summarize the pathophysiological and clinical characteristics of arterial ischemic stroke in children and the most recent international guidelines and practical directions on how to recognise and manage it in paediatric emergency.