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Gonzalez-Salido J, Barron-Cervantes NM, Colado-Martinez J, Arechavala Lopez SF, Mosqueda-Larrauri VL, Ortiz-Herrera JL, Piña-Rosales E, Martinez-Bautista J. Ischemic Stroke as an Initial Manifestation of Antiphospholipid Syndrome in an Adolescent: A Case Report. Cureus 2024; 16:e55579. [PMID: 38576686 PMCID: PMC10994399 DOI: 10.7759/cureus.55579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
Cerebrovascular diseases in pediatric patients are relatively rare. Ischemic stroke in adolescents is associated with a poor prognosis. The most common causes include systemic diseases, such as heart disease and hypercoagulation disorders. It is important to mention that one of the most common acquired hypercoagulation states is the antiphospholipid syndrome (APS). Patients with this disease may present stroke as the first clinical manifestation, which not only increases morbidity in these patients but presents a diagnostic challenge. This case presents one example of how APS can present as a pediatric stroke. The diagnostic approach should always be through the presence of specific antibodies accompanied by the presence of a thromboembolic episode proven by catheterization or an imaging study. In the brain, the preferred imaging study is magnetic resonance imaging. Management is based on anticoagulation therapy and continuous monitoring in the intensive care unit.
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2
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Khan NT, Islam S, Bari A. A Case Report of Moyamoya Disease Presenting as Recurrent Right-Sided Weakness. Cureus 2023; 15:e39209. [PMID: 37337506 PMCID: PMC10276891 DOI: 10.7759/cureus.39209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/21/2023] Open
Abstract
Moyamoya disease is a cerebrovascular condition characterized by progressive occlusion of the cerebral vessels, particularly in the circle of Willis. This report describes the case of a 12-year-old boy presenting with a history of recurrent right-sided weakness over a period of seven years. Magnetic resonance imaging revealed evidence of both old and recent infarcts, as well as encephalomalacic changes. The diagnosis was confirmed by magnetic resonance angiography, which demonstrated severe stenosis in both internal carotid arteries and the presence of significant collateral formation. In Bangladesh, surgical revascularization for Moyamoya disease had not been previously attempted, and due to financial constraints, the patient's family opted for conservative management with anti-platelet therapy and regular follow-ups. Although a hereditary component is often presumed in Moyamoya disease, no such familial history was identified in this case. Additionally, no associations with immunological, infectious, hematological, vascular, or congenital syndromes were found. Mortality rates for Moyamoya disease are approximately 10% in adults and 4.3% in children, with a significant proportion of affected individuals experiencing cognitive decline. However, the patient in this case maintained intact cognitive function, and with diligent follow-up and anticoagulation therapy, it was anticipated that his functional capacity would remain stable.
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Affiliation(s)
- Nabila T Khan
- Department of Gastroenterology, Delta Hospital, Dhaka, Dhaka, BGD
| | - Sumona Islam
- Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Amit Bari
- Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, BGD
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3
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Sporns PB, Rusche T, Lee S, Hanning U, Meyer L, Faizy T, Fiehler J, Psychogios M, Kemmling A, Broocks G. Impact of edema formation on functional outcome in pediatric stroke patients. Eur J Neurol 2023; 30:150-154. [PMID: 36168926 DOI: 10.1111/ene.15576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Quantitative lesion net water uptake (NWU) has been described as an imaging biomarker reflecting vasogenic edema as an early indicator of infarct progression. We hypothesized that edema formation measured by NWU is higher in children compared to adults but despite this functional outcome may be better in children. METHODS This study analyzed children enrolled in the Save ChildS Study who had baseline and follow-up computed tomography available and the data were compared to adult patients. RESULTS Some 207 patients, of whom 13 were children and 194 were adults, were analyzed. Median NWU at baseline was 7.8% (IQR: 4.3-11.3), and there were no significant differences between children and adults (7.5% vs. 7.8%; p = 0.87). The early edema progression rate was 3.0%/h in children and 2.3%/h in adults. Median ΔNWU was 15.1% in children and 10.5% in adults. Children had significantly more often excellent (mRS 0-1; children 10/13 = 77% vs. adults 28/196 = 14%; p < 0.0001) and favorable clinical outcomes (mRS 0-2, 12/13 = 92% vs. 39/196 = 20%; p < 0.0001). CONCLUSIONS In this study, clinical outcomes in children with large vessel occlusion strokes were better than in adults despite similar clinical and imaging characteristics and similar edema formation. This may be impacted by the generally better outcomes of children after strokes but may demonstrate that the degree of early ischemic changes using Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and edema progression rate may not be a reason for exclusion from endovascular thrombectomy.
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Affiliation(s)
- Peter B Sporns
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thilo Rusche
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marios Psychogios
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Andre Kemmling
- Department of Neuroradiology, University Hospital Marburg, Marburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Sporns PB, Kemmling A, Lee S, Fullerton H, Kunz WG, Wilson JL, Mackay MT, Steinlin M, Fiehler J, Psychogios M, Wildgruber M. A Prospective Multicenter Registry on Feasibility, Safety, and Outcome of Endovascular Recanalization in Childhood Stroke (Save ChildS Pro). Front Neurol 2021; 12:736092. [PMID: 34539563 PMCID: PMC8446378 DOI: 10.3389/fneur.2021.736092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 07/30/2021] [Indexed: 11/19/2022] Open
Abstract
Rationale: Early evidence for the benefit of mechanical thrombectomy (MT) in pediatric patients with intracranial large vessel occlusion has been shown in previous retrospective cohorts. Higher-level evidence is needed to overcome the limitations of these studies such as the lack of a control group and the retrospective design. Randomized trials will very likely not be feasible, and several open questions remain, for example, the impact of arteriopathic etiologies or a possible lower age limit for MT. Save ChildS Pro therefore aims to demonstrate the safety and effectiveness of MT in pediatric patients compared to the best medical management and intravenous thrombolysis. Design: Save ChildS Pro is designed as a worldwide multicenter prospective registry comparing the safety and effectiveness of MT to the best medical care alone in the treatment of pediatric arterial ischemic stroke (AIS). It will include pediatric patients (<18 years) with symptomatic acute intracranial arterial occlusion who underwent either MT or best medical treatment including intravenous thrombolysis. Outcomes: The primary endpoint of Save ChildS Pro is the modified Rankin Scale score at 90 days post-stroke. Secondary endpoints will comprise the decrease of the Pediatric National Institutes of Health Stroke Scale score from admission to discharge and rate of complications. Discussion: Save ChildS Pro aims to provide high-level evidence for MT for pediatric patients with AIS, thereby improving functional outcome and quality of life and reducing the individual, societal, and economic burden of death and disability resulting from pediatric stroke. Clinical Trial Registration: Save ChildS Pro is registered at the German Clinical Trials Registry (DRKS; identifier: DRKS00018960).
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Affiliation(s)
- Peter B Sporns
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Kemmling
- Department of Neuroradiology, University Hospital Marburg, Marburg, Germany
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology, Stanford University, Stanford, CA, United States
| | - Heather Fullerton
- Department of Neurology and Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, Munich, Germany
| | - Jenny L Wilson
- Division of Pediatric Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Mark T Mackay
- Department of Neurology, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Maja Steinlin
- Division of Neuropediatrics, Development and Rehabilitation, Children's University Hospital, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marios Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
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5
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Liu M, Zhang J, Wen M, Zhang M. Concurrent maxillary herpes zoster, meningitis, focal cerebral arteriopathy, and ischemic stroke: A case report. Clin Case Rep 2020; 8:2803-2808. [PMID: 33363826 PMCID: PMC7752611 DOI: 10.1002/ccr3.3278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/19/2020] [Accepted: 08/05/2020] [Indexed: 12/23/2022] Open
Abstract
Secondary headache, fever, and upper motor neuron signs following facial herpes zoster during childhood should alert clinicians to the possibility of central nervous system complications of varicella-zoster virus infection.
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Affiliation(s)
- Mao Liu
- Department of NeurologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Jing Zhang
- Department of RadiologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Mimi Wen
- Department of NeurologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Min Zhang
- Department of NeurologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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Abstract
Background Several randomized trials have shown the efficacy of thrombectomy for large intracranial vessel occlusions in adults. However, the safety and efficacy of thrombectomy in children are unknown. We aimed to investigate the feasibility and outcome of thrombectomy in pediatric patients. Methods and Results We performed a retrospective analysis of all children (<18 years of age) who presented with large-vessel occlusion and were treated with mechanical thrombectomy at 3 German tertiary-care stroke centers. Interventional results and clinical outcomes were assessed using the Pediatric National Institutes of Health Stroke Scale at 24 hours and on day 7 after thrombectomy as well as after 3 months (modified Rankin Scale). After screening of local registries for all performed thrombectomies, 12 children were included. Median Pediatric National Institutes of Health Stroke Scale score on admission was 12.5 (interquartile range 8.0-21.5). Angiographic outcomes for thrombectomy were good in all patients (6×modified Treatment in Cerebral Infarction Score 3, 6×modified Treatment in Cerebral Infarction Score 2b). Moreover, most patients showed an improvement of neurological outcome after thrombectomy with a median Pediatric National Institutes of Health Stroke Scale of 3.5 (interquartile range 1-8) at day 7 and a modified Rankin Scale of 1.0 (interquartile range 0-2.0) at 3 months. No major periprocedural complications were observed. Conclusions In our retrospective study thrombectomy was safe in childhood stroke, and treated children had good neurological outcomes.
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Affiliation(s)
- Peter B Sporns
- 1 Institute of Clinical Radiology University Hospital of Muenster Germany
| | - André Kemmling
- 1 Institute of Clinical Radiology University Hospital of Muenster Germany.,2 Department of Neuroradiology University Hospital of Luebeck Germany
| | - Uta Hanning
- 3 Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Jens Minnerup
- 4 Department of Neurology University of Muenster Germany
| | - Ronald Sträter
- 5 Department of Pediatrics University of Muenster Germany
| | - Thomas Niederstadt
- 1 Institute of Clinical Radiology University Hospital of Muenster Germany
| | - Walter Heindel
- 1 Institute of Clinical Radiology University Hospital of Muenster Germany
| | - Moritz Wildgruber
- 1 Institute of Clinical Radiology University Hospital of Muenster Germany
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7
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Gervelis WL, Golomb MR. Mechanical Thrombectomy in Pediatric Stroke: Report of Three New Cases. J Stroke Cerebrovasc Dis 2019; 29:104551. [PMID: 31843352 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/01/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Mechanical thrombectomy for treatment of arterial ischemic stroke (AIS) and cerebral venous thrombosis (CVT) is well-studied in adult populations, but not in children. METHODS We report 3 new cases of pediatric stroke treated using mechanical thrombectomy. Two cases of AIS and 1 case of CVT were identified from 2018 pediatric stroke clinic records. RESULTS Thrombectomy was successful in 1 of the 2 AIS cases and in the CVT case. None of the children were asymptomatic after thrombectomy. One AIS case had good recovery than developed dystonia which responded to treatment; the second AIS case had residual hemiplegia; and the child with CVT had mild school problems. CONCLUSIONS Mechanical thrombectomy is being increasingly used for pediatric stroke treatment. This study and recent literature reviews suggest thrombectomy holds promise as a treatment for selected pediatric stroke patients. Questions remain about the safety and efficacy of thrombectomy in children with stroke since large randomized controlled studies are not yet feasible.
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Affiliation(s)
- Whitney L Gervelis
- Division of Child Neurology, Department of Neurology, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana
| | - Meredith R Golomb
- Division of Child Neurology, Department of Neurology, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana.
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Abstract
The majority of pediatric neuropsychological stroke research has focused on perinatal stroke outcomes given its relative frequency. Meanwhile, childhood-onset stroke is under-represented in the literature, resulting in limited knowledge about its neurocognitive sequelae. This retrospective study examined cognitive outcomes in children and youth (n = 27) with childhood arterial ischemic stroke (stroke occurring between 29 days and 18 years of life) isolated to the cortical region. Intellectual, academic, language, visual-perception, visual-motor integration, fine motor coordination, and executive function scores were examined relative to normative means. Results indicate that although these children are doing well in terms of general intellectual ability, they demonstrate lower scores on tasks of processing speed and fine motor coordination. Exploratory analysis also revealed that of the personal and neurologic factors examined, age at stroke was positively correlated with perceptual reasoning and fine motor control, age at assessment was negatively correlated with math calculation abilities, and maternal education was positively correlated with working memory and parent-reported behavioral regulation and impulse inhibition abilities. While neurologic variables were not predictive of cognitive neuropsychological outcomes, those with significant poorer performance had higher rates of medium/large, right-sided lesions with frontal lobe involvement. Our results highlight the overall resilience of the injured developing brain but also the vulnerability of specific cognitive skills within this unique population.
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Affiliation(s)
- Rachel K Peterson
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Children's Stroke Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Tricia S Williams
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Children's Stroke Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kyla P McDonald
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Children's Stroke Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nomazulu Dlamini
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Children's Stroke Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Robyn Westmacott
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Children's Stroke Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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9
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Abstract
Moyamoya disease is a chronic progressive cerebrovascular occlusive disease of the terminal portion of the internal carotid arteries associated with an acquired abnormal vascular network at the base of the brain, often leading to ischemic or hemorrhagic stroke. Moyamoya disease is a relatively common cause of pediatric stroke with a specific racial and well-identified clinical and imaging phenotype. Moyamoya disease is more prevalent in East Asian countries compared with other geographic regions with a higher incidence of familial cases and clinically more aggressive form. Moyamoya disease is one of the few causes of stroke that is amenable to effective surgical revascularization treatment. There are various surgical options available for revascularization, including the direct, indirect, or combined bypass techniques, each with variable responses. However, due to the heterogeneity of the diseases, different clinical course, geographical variables associated with the disease, and availability of a wide variety of surgical revascularization procedures, optimal selection of a surgical candidate and the surgical technique becomes challenging, particularly in the pediatric population. This brief review presents pertinent literature of clinical options for the diagnosis and surgical treatment of moyamoya disease in children.
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Affiliation(s)
- Ramana Appireddy
- 1 Division of Neurology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Manish Ranjan
- 2 Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA.,3 Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Bryce A Durafourt
- 1 Division of Neurology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Jay Riva-Cambrin
- 4 Division of Pediatric Neurosurgery, Department of Clinical Neurosciences, Alberta Children's Hospital, Calgary, University of Calgary, Alberta, Canada
| | - Walter J Hader
- 4 Division of Pediatric Neurosurgery, Department of Clinical Neurosciences, Alberta Children's Hospital, Calgary, University of Calgary, Alberta, Canada
| | - P David Adelson
- 2 Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
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10
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Peterson RK, McDonald KP, Vincent M, Williams TS, Dlamini N, Westmacott R. Characterizing language outcomes following childhood basal ganglia stroke. Appl Neuropsychol Child 2019; 10:14-25. [PMID: 31006275 DOI: 10.1080/21622965.2019.1590202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The basal ganglia are important for movement and executive function, but its contribution to language is less understood. This study explored language outcomes associated with childhood basal ganglia stroke. A detailed language coding scheme, which examined expressive and receptive language, verbal fluency, narrative discourse, pragmatic/applied language, and academics, was developed from qualitative and quantitative data acquired from neuropsychological testing and reports. Overall intellectual functioning and verbal comprehension was in the average range. Twelve participants had psychological diagnoses, including Learning Disorder. No one had a Language Disorder diagnosis. Among the 18 children who did not receive a diagnosis, many exhibited language issues in the mild to severe range according to our coding scheme. These children had higher-order language difficulties in verbal fluency, narrative, and pragmatic language rather than overt expressive difficulties noted in Diagnostic and Statistical Manual (DSM) diagnostic criteria. There was an association between infarct size and ESL/immersion education, math performance, and presence of a psychological diagnosis. Psychological diagnosis was also associated with literacy skills. The results highlight that language issues following basal ganglia stroke may not be fully captured by standardized neuropsychological tests and psychological diagnoses. Findings reinforce the need to integrate quantitative and qualitative findings when examining language functioning.
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Affiliation(s)
- Rachel K Peterson
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kyla P McDonald
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Megan Vincent
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tricia S Williams
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nomazulu Dlamini
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robyn Westmacott
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Nuara A, Papangelo P, Avanzini P, Fabbri-Destro M. Body Representation in Children With Unilateral Cerebral Palsy. Front Psychol 2019; 10:354. [PMID: 30837926 PMCID: PMC6389686 DOI: 10.3389/fpsyg.2019.00354] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 02/05/2019] [Indexed: 11/25/2022] Open
Abstract
Drawings produced by children provide insights about their physical and psychological status. In children suffering from unilateral cerebral palsy (UCP), self-portraits constitute a unique opportunity to study whether and how their disease affects self-body representation. The aim of the present study is to evaluate self-body representation in UCP children, comparing it to the way they portray both healthy and hemiparetic peers. Ten UCP children were asked to perform 3 drawings: a self-portrait, a portrait of their best classmate, and finally a portrait of a hemiparetic peer who had joint them in a child-to-child rehabilitation protocol. As controls, 16 typically developing children were asked to perform a self-portrait, and their best-classmate portrait. The asymmetry index (AI), consisting of the difference between the upper limbs length expressed as percentage of their average, resulted greater in UCP than in controls’ self-portrait. More interestingly, UCP children portrayed themselves more asymmetrically relative to their classmates and hemiparetic peers. No difference in terms of AI was found between self- vs. classmate-portrait in the control group. This study provides evidence that UCP affects body self-representation, but not body-representation in general. In fact, the asymmetry in upper limb representation observed in children with UCP does not constitute a mere picturing of the hemiparesis, but rather reflects the experienced status of functioning, that is valid only for one’s own. The inclusion of portraits in pediatric neurorehabilitation programs might enable clinicians to collect additional evidence about the children self-perceived functioning, i.e., an information not easily obtainable in pediatric patients.
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Affiliation(s)
- Arturo Nuara
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Parma, Italy.,Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
| | - Pamela Papangelo
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Parma, Italy
| | - Pietro Avanzini
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Parma, Italy
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12
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Abstract
OBJECTIVE Here we review the current literature regarding visual outcome after perinatal and childhood stroke. BACKGROUND Visual deficits following stroke in adults are common and have been previously reviewed. Less is known about visual deficits following stroke in neonates and older children. Most of the literature regarding this subject has focused on preterm infants, or on other types of brain injury. This review summarizes the types of visual deficits seen in term infants following perinatal stroke and children following childhood stroke and predictors of outcome. This review suggests areas for future research. METHODS We performed Ovid MEDLINE searches regarding visual testing in children, vision after childhood stroke, neuroplasticity of vision, treatment of visual impairment after stroke, and driving safety concerns after stroke. RESULTS Visual field defects were the most commonly reported visual deficits after perinatal and childhood stroke. There is a significant lack of literature on this subject, and most is in the form of case reports and case series. Children can experience significant visual morbidity after stroke, and have the potential to show some recovery, but guidelines on assessment and treatment of this population are lacking. CONCLUSIONS There were limitations to this study, given the small amount of literature available. Although stroke in children can result in severe visual deficits, most children regain at least a portion of their vision. However, more research is needed regarding visual assessment of this population, long-term visual outcomes, specific predictors of recovery, and treatment options.
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Affiliation(s)
- Lauren B Crawford
- Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Meredith R Golomb
- Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana.
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13
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Yvon E, Lamotte D, Tiberghien A, Godard I, Mardaye A, Laurent-Vannier A, Agostini MD, Chevignard M. Long-term motor, functional, and academic outcome following childhood ischemic and hemorrhagic stroke: A large rehabilitation center-based retrospective study. Dev Neurorehabil 2018; 21:83-90. [PMID: 27841719 DOI: 10.1080/17518423.2016.1247923] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To study the long-term outcomes following childhood ischemic and hemorrhagic stroke. METHODS This was a retrospective study, looking at children consecutively admitted to a rehabilitation department following childhood stroke. We collected demographic, medical, and severity data, motor deficit, cognitive assessment, and long-term academic outcome. RESULTS One hundred and twenty-eight children were included, following arterial ischemic (AIS; n = 46) or hemorrhagic (HS; n = 82) stroke. At discharge, motor deficit was still present in 70% of children (versus 89% immediately after stroke). HS predicted significantly better motor and functional outcomes than AIS. After a median follow-up of 43 months, 40% received special education. The receipt of special education was predicted by persistent motor deficit, but when full-scale IQ was taken into account, IQ was the only significant predictor of special education. CONCLUSIONS Childhood stroke leads to severe and long lasting motor, functional, cognitive, and academic impairments, in a population of children admitted in a rehabilitation department.
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Affiliation(s)
- Estelle Yvon
- a Rehabilitation Department for Children with Acquired Neurological Injury , Saint Maurice Hospitals , Saint Maurice , France
| | - Delphine Lamotte
- b Rehabiliation Department , Reine Hortense Hospital , Aix-Les-Bains , France
| | - Anne Tiberghien
- c Outreach team for Children and Adolescents with Acquired Brain Injury , Saint Maurice Hospitals , Saint Maurice , France
| | - Ingrid Godard
- d French National Reference Centre for Childhood Stroke , Bellevue Hospital , Saint Etienne , France
| | - Alain Mardaye
- d French National Reference Centre for Childhood Stroke , Bellevue Hospital , Saint Etienne , France
| | - Anne Laurent-Vannier
- a Rehabilitation Department for Children with Acquired Neurological Injury , Saint Maurice Hospitals , Saint Maurice , France.,c Outreach team for Children and Adolescents with Acquired Brain Injury , Saint Maurice Hospitals , Saint Maurice , France
| | - Maria De Agostini
- e Inserm, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS) , Developmental Origins of Health and Disease (ORCHAD) Team , Villejuif , France.,f Paris Descartes University , Paris, France
| | - Mathilde Chevignard
- a Rehabilitation Department for Children with Acquired Neurological Injury , Saint Maurice Hospitals , Saint Maurice , France.,d French National Reference Centre for Childhood Stroke , Bellevue Hospital , Saint Etienne , France.,g Sorbonne Universités, UPMC University Paris 06, CNRS UMR 7371, INSERM UMR S 1146 , Laboratoire d'Imagerie Biomédicale (LIB) , Paris , France.,h Sorbonne Universités, UPMC Univ Paris 06, AP-HP, GRC n°18, Handicap Cognitif et Réadaptation (HanCRe), Hôpitaux de Saint Maurice, Paris, France
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14
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Bonfert MV, Badura K, Gerstl J, Borggraefe I, Heinen F, Schroeder S, Olivieri M, Weinberger R, Landgraf MN, Vill K, Tacke M, Berweck S, Reiter K, Hoffmann F, Nicolai T, Gerstl L. Childhood Stroke: Awareness, Interest, and Knowledge Among the Pediatric Community. Front Pediatr 2018; 6:182. [PMID: 29988546 PMCID: PMC6026646 DOI: 10.3389/fped.2018.00182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/04/2018] [Indexed: 12/11/2022] Open
Abstract
Objective: Acute childhood stroke is an emergency requiring a high level of awareness among first-line healthcare providers. This survey serves as an indicator of the awareness of, the interest in, and knowledge of childhood stroke of German pediatricians. Methods: Thousand six hundred and ninety-seven physicians of pediatric in- and outpatient facilities in Bavaria, Germany, were invited via email to an online-survey about childhood stroke. Results: The overall participation rate was 14%. Forty-six percent of participants considered a diagnosis of childhood stroke at least once during the past year, and 47% provide care for patients who have suffered childhood stroke. The acronym FAST (Face-Arm-Speech-Time-Test) was correctly cited in 27% of the questionnaires. Most commonly quoted symptoms of childhood stroke were hemiparesis (90%), speech disorder (58%), seizure (44%), headache (40%), and impaired consciousness (33%). Migraine (63%), seizure (39%), and infections of the brain (31%) were most frequently named as stroke mimics. Main diagnostic measures indicated were magnetic resonance imaging (MRI) (96%) and computer tomography (CT) (55%). Main therapeutic strategies were thrombolysis (80%), anticoagulation (41%), neuroprotective measures, and thrombectomies (15% each). Thirty-nine percent of participants had taken part in training sessions, 61% studied literature, 37% discussed with colleagues, and 25% performed internet research on childhood stroke. Ninety-three percent of participants approve skill enhancement, favoring training sessions (80%), publications (43%), and web based offers (35%). Consent for offering a flyer on the topic to caregivers in facilities was given in 49%. Conclusion: Childhood stroke constitutes a topic of clinical importance to pediatricians. Participants demonstrate a considerable level of comprehension concerning the subject, but room for improvement remains. A multi-modal approach encompassing an elaborate training program, regular educational publications in professional journals, and web based offers could reach a broad range of health care providers. Paired with a public adult and childhood stroke awareness campaign, these efforts could contribute to optimize the care for children suffering from stroke.
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Affiliation(s)
- Michaela V Bonfert
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Katharina Badura
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany.,Schön Klinik Vogtareuth, Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Vogtareuth, Germany
| | - Julia Gerstl
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany.,Department of Pediatrics, Facharztzentrum Hauzenberg, Hauzenberg, Germany
| | - Ingo Borggraefe
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Florian Heinen
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Sebastian Schroeder
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Martin Olivieri
- Department of Pediatric Hemostaseology, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany.,Pediatric Intensive Care Unit, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Raphael Weinberger
- Division of Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Mirjam N Landgraf
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Katharina Vill
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Moritz Tacke
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Steffen Berweck
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany.,Schön Klinik Vogtareuth, Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Vogtareuth, Germany
| | - Karl Reiter
- Pediatric Intensive Care Unit, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Florian Hoffmann
- Pediatric Intensive Care Unit, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Thomas Nicolai
- Pediatric Intensive Care Unit, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Lucia Gerstl
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
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Christy A, Murchison C, Wilson JL. Quick Brain Magnetic Resonance Imaging With Diffusion-Weighted Imaging as a First Imaging Modality in Pediatric Stroke. Pediatr Neurol 2018; 78:55-60. [PMID: 29174005 DOI: 10.1016/j.pediatrneurol.2017.09.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/27/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Diagnostic delay hinders management of pediatric arterial ischemic stroke. Quick brain MRI with diffusion-weighted imaging sequences may provide a rapid diagnosis without the ionizing radiation of a computed tomography (CT) scan. METHODS This was a single center retrospective chart review of children one month to 18 years old with acute arterial ischemic stroke hospitalized between January 2010 and January 2017. We evaluated sensitivity and the time to diagnostic study based on the first imaging study (CT or quick brain MRI with diffusion-weighted imaging). RESULTS Twenty-five patients were included. Eleven patients (44%) were initially assessed with CT, 10 (40%) with quick brain MRI with diffusion-weighted imaging, and four (16%) with a full MRI. Compared with children undergoing CT, children with quick brain MRI with diffusion-weighted imaging as first study were younger (5.8 versus 14.1 years, P < 0.001) and were more likely to be hospitalized at stroke onset (70% versus 18.2%, P = 0.03). Quick brain MRI with diffusion-weighted imaging was more sensitive for ischemia than CT (100% versus 27.3%). The median time from presentation to diagnostic imaging was 4.3 hours, with no differences between CT and quick brain MRI with diffusion-weighted imaging groups, although the quick brain MRI with diffusion-weighted imaging group had a shorter median time from first imaging to diagnostic imaging (P = 0.002). There were no significant missed findings on quick brain MRI with diffusion-weighted imaging. CONCLUSIONS Quick brain MRI with diffusion-weighted imaging was more sensitive than CT for detecting ischemia and may be considered as the first study for some children presenting with suspected arterial ischemic stroke.
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Abstract
OBJECTIVES The aim of this paper was to critically review the recent literature on psychosocial and behavioral outcome following childhood stroke, to assess whether quality of life is affected and to investigate the factors related to psychosocial outcome. METHODS Literature searches were conducted and identified 36 relevant papers from the period 1908-2016. RESULTS The systematic review found that many children experience difficulties in a wide range of psychosocial domains. Quality of life can also be significantly reduced. Inconsistent findings regarding the correlates of outcome are likely due to methodological limitations. These issues include small and heterogeneous samples, lack of control groups, and measurement difficulties. CONCLUSIONS This systematic review strongly indicates that childhood stroke can affect a myriad of psychosocial domains and a child's quality of life. Methodological issues, particularly around heterogeneous samples and measures, limit the conclusions that can be drawn regarding the predictors of outcome.
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Affiliation(s)
- Fiadhnait O'Keeffe
- a Research Department of Clinical, Health and Educational Psychology , University College London , London , UK.,b Department of Clinical Psychology , National Rehabilitation Hospital, Dun Laoghaire, Co . Dublin , Ireland
| | - Daniel Stark
- c Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust , London , UK
| | - Orlagh Murphy
- b Department of Clinical Psychology , National Rehabilitation Hospital, Dun Laoghaire, Co . Dublin , Ireland
| | - Vijeya Ganesan
- c Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust , London , UK
| | - John King
- a Research Department of Clinical, Health and Educational Psychology , University College London , London , UK
| | - Tara Murphy
- c Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust , London , UK
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17
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McDonough TL, Paolicchi JM, Heier LA, Das N, Engel M, Perlman JM, Grinspan ZM. Prediction of Future Epilepsy in Neonates With Hypoxic-Ischemic Encephalopathy Who Received Selective Head Cooling. J Child Neurol 2017; 32:630-637. [PMID: 28359187 DOI: 10.1177/0883073817698628] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Epilepsy outcomes after therapeutic hypothermia for neonates with hypoxic-ischemic encephalopathy are understudied. The authors used multivariable logistic regression to predict epilepsy in neonates after selective head cooling. Sensitivity analyses used magnetic resonance imaging (MRI) and electroencephalogram (EEG) interpretations by different clinicians. Fifty neonates had 2-year follow-up. Nine developed epilepsy. Predictors included pH ≤6.8 on day of birth (adjusted odds ratio [OR] 19 [95% confidence interval (CI) 1-371]), burst suppression on EEG on day 4 (8.2 [1.3-59]), and MRI deep gray matter injury (OR 33 [2.4-460]). These factors stratify neonates into low (0-1 factors; 3% [0%-14%] risk), medium (2 factors; 56% [21%-86%] risk), and high-risk groups (3 factors; 100% [29%-100%] risk) for epilepsy. The stratification was robust to varying clinical interpretations of the MRI and EEG. Neonates with hypoxic-ischemic encephalopathy who undergo selective head cooling appear at risk of epilepsy if they have 2 to 3 identified factors. If validated, this rule may help counsel families and identify children for close clinical follow-up.
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Affiliation(s)
- Tiffani L McDonough
- 1 Division of Child Neurology, Columbia University Medical Center, New York, NY, USA
| | | | - Linda A Heier
- 3 Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Nikkan Das
- 4 Weill Cornell Medical College, New York, NY, USA
| | - Murray Engel
- 5 Division of Child Neurology, Weill Cornell Medical Center, New York, NY, USA
| | - Jeffrey M Perlman
- 6 Division of Neonatology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Zachary M Grinspan
- 5 Division of Child Neurology, Weill Cornell Medical Center, New York, NY, USA.,7 Department of Healthcare Policy & Research, Division of Health Policy and Economics, Weill Cornell Medical College, New York, NY, USA
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18
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Mirsky DM, Beslow LA, Amlie-Lefond C, Krishnan P, Laughlin S, Lee S, Lehman L, Rafay M, Shaw D, Rivkin MJ, Wintermark M. Pathways for Neuroimaging of Childhood Stroke. Pediatr Neurol 2017; 69:11-23. [PMID: 28274641 DOI: 10.1016/j.pediatrneurol.2016.12.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/07/2016] [Accepted: 12/08/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND The purpose of this article is to aid practitioners in choosing appropriate neuroimaging for children who present with symptoms that could be caused by stroke. METHODS The Writing Group members participated in one or more pediatric stroke neuroimaging symposiums hosted by the Stroke Imaging Laboratory for Children housed at the Hospital for Sick Children in Toronto, Ontario, Canada. Through collaboration, literature review, and discussion among child neurologists with expertise diagnosing and treating childhood stroke and pediatric neuroradiologists and neuroradiologists with expertise in pediatric neurovascular disease, suggested imaging protocols are presented for children with suspected stroke syndromes including arterial ischemic stroke, cerebral sinovenous thrombosis, and hemorrhagic stroke. RESULTS This article presents information about the epidemiology and classification of childhood stroke with definitions based on the National Institutes of Health Common Data Elements. The role of imaging for the diagnosis of childhood stroke is examined in depth, with separate sections for arterial ischemic stroke, cerebral sinovenous thrombosis, and hemorrhagic stroke. Abbreviated neuroimaging protocols for rapid diagnosis are discussed. The Writing Group provides suggestions for optimal neuroimaging investigation of various stroke types in the acute setting and suggestions for follow-up neuroimaging. Advanced sequences such as diffusion tensor imaging, perfusion imaging, and vessel wall imaging are also discussed. CONCLUSIONS This article provides protocols for the imaging of children who present with suspected stroke.
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Affiliation(s)
- David M Mirsky
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
| | - Lauren A Beslow
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Catherine Amlie-Lefond
- Department of Neurology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Pradeep Krishnan
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Suzanne Laughlin
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Lee
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, California
| | - Laura Lehman
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mubeen Rafay
- Section of Neurology, Children's Hospital, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dennis Shaw
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Michael J Rivkin
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Max Wintermark
- Division of Neuroradiology, Department of Radiology, Stanford University School of Medicine, Stanford, California
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Mackay MT, Stojanovski B, Mosley I, Churilov L, Donnan GA, Monagle P. Parental Care-Seeking Behavior and Prehospital Timelines of Care in Childhood Arterial Ischemic Stroke. Stroke 2016; 47:2638-40. [PMID: 27608817 DOI: 10.1161/strokeaha.116.014728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 08/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Taking appropriate action in the prehospital setting is important for rapid stroke diagnosis in adults. Data are lacking for children. We aimed to describe parental care-seeking behavior and prehospital timelines of care in childhood arterial ischemic stroke. METHODS A structured questionnaire was developed, using value-focused event-driven conceptual modeling techniques, to interview parents of children presenting to the emergency department with arterial ischemic stroke from 2008 to 2014. RESULTS Twenty-five parents (median age 41 years, interquartile range 36-45) were interviewed. Twenty-four children were awake, and 1 child was asleep at stroke onset; 23 had sudden onset symptoms. Location at stroke onset included home (72%), school (8%), or other setting (20%). Carergivers present included parent (76%), another child (8%), teacher (4%), or alone (8%). Eighty-four percent of parents thought symptoms were serious, and 83% thought immediate action was required, but only 48% considered the possibility of stroke. Initial actions included calling an ambulance (36%), wait and see (24%), calling a general practitioner (16%) or family member (8%), and driving to the emergency department or family physician (both 8%). Median time from onset to emergency department arrival was 76 minutes (interquartile range 53-187), being shorter for ambulance-transported patients. CONCLUSIONS Stroke recognition and care-seeking behavior are suboptimal, with less than half the parents considering stroke or calling an ambulance. Initiatives are required to educate parents about appropriate actions to facilitate time-critical interventions.
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Affiliation(s)
- Mark T Mackay
- From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia.
| | - Belinda Stojanovski
- From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia
| | - Ian Mosley
- From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia
| | - Leonid Churilov
- From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia
| | - Geoffrey A Donnan
- From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia
| | - Paul Monagle
- From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia
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20
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Kirschen MP, Dori Y, Itkin M, Licht DJ, Ichord R, Vossough A. Cerebral Lipiodol Embolism after Lymphatic Embolization for Plastic Bronchitis. J Pediatr 2016; 176:200-3. [PMID: 27297208 DOI: 10.1016/j.jpeds.2016.05.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/07/2016] [Accepted: 05/11/2016] [Indexed: 11/22/2022]
Abstract
An adolescent with plastic bronchitis due to congenital heart disease had altered mental status after an interventional lymphatic procedure in which lipiodol contrast was used. Neuroimaging revealed cerebral lipiodol embolization due to direct shunting between lymphatic channels and pulmonary veins. Cerebral lipiodol embolization is a potential neurologic morbidity associated with interventional lymphatic procedures.
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21
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Kirton A, Williams E, Dowling M, Mah S, Hodge J, Carlson H, Wei XC, Ichord R. Diffusion imaging of cerebral diaschisis in childhood arterial ischemic stroke. Int J Stroke 2016; 11:1028-1035. [PMID: 27550558 DOI: 10.1177/1747493016666089] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/20/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diffusion-weighted imaging magnetic resonance imaging may detect changes in brain structures remote but connected to stroke consistent with neuropathological descriptions of diaschisis. Early diffusion-weighted imaging demonstrates restriction in corticospinal pathways after arterial ischemic stroke of all ages that correlates with motor outcome. AIM/HYPOTHESIS We hypothesized that cerebral diaschisis is measurable in childhood arterial ischemic stroke and explored associations with outcome. METHODS This sub-study of the validation of the Pediatric NIH Stroke Scale study prospectively enrolled children with acute arterial ischemic stroke and both acute and early follow-up (5-14 days) diffusion-weighted imaging. Inclusion criteria were (1) unilateral middle cerebral artery arterial ischemic stroke, (2) acute and subacute diffusion-weighted imaging (b = 1000), and (3) 12 month neurological follow-up (Pediatric Stroke Outcome Measure). A validated method using ImageJ software quantified diffusion-weighted imaging diaschisis in anatomically connected structures. Diaschisis measures were corrected for infarct volume, compared to age, imaging timing, and outcomes (Chi square/Fisher, Mann-Whitney test). RESULTS Nineteen children (53% male, median 8.1 years) had magnetic resonance imaging at medians of 21 and 168 h post-stroke onset. Diaschisis was common and evolved over time, observed in one (5%) on acute but eight (42%) by follow-up diffusion-weighted imaging. Thalamic and callosal diaschisis were most common (5, 26%). Estimates of perilesional diaschisis varied (54 ± 18% of infarct volume). Children with diaschisis tended to be younger (7.02 ± 5.4 vs. 11.82 ± 4.3 years, p = 0.08). Total diaschisis score was associated with poor cognitive outcomes (p = 0.03). Corticospinal tract diaschisis was associated with motor outcome (p = 0.004). Method reliability was excellent. CONCLUSIONS Diffusion-weighted imaging diaschisis occurs in childhood arterial ischemic stroke. Mistaking diaschisis for new areas of infarction carries important clinical implications. Improved recognition and study are required to establish clinical relevance.
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Affiliation(s)
- Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Elizabeth Williams
- Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael Dowling
- Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah Mah
- Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jacquie Hodge
- Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Helen Carlson
- Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Xing-Chang Wei
- Department of Radiology, Alberta Children's Hospital, Calgary, AB, Canada
| | - Rebecca Ichord
- The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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22
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Adil MM, Vidal GA, Beslow LA. Clinical Outcomes among Transferred Children with Ischemic and Hemorrhagic Strokes in the Nationwide Inpatient Sample. J Stroke Cerebrovasc Dis 2016; 25:2594-2602. [PMID: 27453219 DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/03/2016] [Accepted: 06/28/2016] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Children with ischemic stroke (IS) and hemorrhagic stroke (HS) may require interfacility transfer for higher level of care. We compared the characteristics and clinical outcomes of transferred and nontransferred children with IS and HS. METHODS Children aged 1-18 years admitted to hospitals in the United States from 2008 to 2011 with a primary discharge diagnosis of IS and HS were identified from the National Inpatient Sample database by ICD-9 codes. Using logistic regression, we estimated the odds ratios (OR) and 95% confidence intervals (CI) for in-hospital mortality and discharge to nursing facilities (versus discharge home) between transferred and nontransferred patients. RESULTS Of the 2815 children with IS, 26.7% were transferred. In-hospital mortality and discharge to nursing facilities were not different between transferred and nontransferred children in univariable analysis or in multivariable analysis that adjusted for age, sex, and confounding factors. Of the 6879 children with HS, 27.1% were transferred. Transferred compared to nontransferred children had higher rates of both in-hospital mortality (8% versus 4%, P = .003) and discharge to nursing facilities (25% versus 20%, P = .03). After adjusting for age, sex, and confounding factors, in-hospital mortality (OR 1.5, 95% CI 1.1-2.4, P = .04) remained higher in transferred children, whereas discharge to nursing facilities was not different between the groups. CONCLUSION HS but not IS was associated with worse outcomes for children transferred to another hospital compared to children who were not transferred. Additional study is needed to understand what factors may contribute to poorer outcomes among transferred children with HS.
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Affiliation(s)
- Malik M Adil
- Department of Neurology, Ochsner Clinic Foundation, New Orleans, Louisiana.
| | - Gabriel A Vidal
- Department of Neurology, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Lauren A Beslow
- Departments of Pediatrics and Neurology, Yale School of Medicine, New Haven, Connecticut
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23
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Eve M, O'Keeffe F, Jhuty S, Ganesan V, Brown G, Murphy T. Computerized Working-Memory Training for Children Following Arterial Ischemic Stroke: A Pilot Study With Long-Term Follow-Up. Appl Neuropsychol Child 2016; 5:273-82. [PMID: 26980059 DOI: 10.1080/21622965.2015.1055563] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cognitive deficits in the domains of working memory (WM) and executive function are well documented following childhood arterial ischemic stroke (AIS). However, there are currently no evidence-based cognitive interventions for this population. Computerized, implicit WM training has been demonstrated to generate generalized cognitive gains for children with WM and attention deficits and for adults following brain injury. This study used a pilot design to investigate the efficacy and feasibility of such an intervention program (Cogmed WM Training) for a childhood AIS population. Outcomes were measured via psychometric assessment at preintervention and postintervention and again at 1-year follow-up. At longitudinal follow-up, participants were found to have significant and persistent cognitive difficulties, particularly with attention and response inhibition. Following the computerized, implicit WM intervention, a significant improvement in phonological-loop WM was seen; however, this improvement was not maintained after 12 months. No additional significant improvements on standardized psychometric outcome measures were seen either immediately or at 12-month follow-up. Findings of this pilot study therefore do not currently support Cogmed as an effective intervention for children with AIS but highlight the need for further research, including randomized, controlled trials, to investigate cognitive interventions for the childhood AIS population.
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Affiliation(s)
- Megan Eve
- a Department of Clinical Psychology , Royal Holloway University of London , London , United Kingdom
| | - Fiadhnait O'Keeffe
- b Research Department of Clinical, Educational, and Health Psychology , University College London , London , United Kingdom
| | - Simren Jhuty
- c Institute of Child Health , University College London , London , United Kingdom.,d Department of Clinical Neuropsychology , Great Ormond Street Hospital for Children NHS Foundation Trust , London , United Kingdom
| | - Vijeya Ganesan
- c Institute of Child Health , University College London , London , United Kingdom.,d Department of Clinical Neuropsychology , Great Ormond Street Hospital for Children NHS Foundation Trust , London , United Kingdom
| | - Gary Brown
- a Department of Clinical Psychology , Royal Holloway University of London , London , United Kingdom
| | - Tara Murphy
- c Institute of Child Health , University College London , London , United Kingdom.,d Department of Clinical Neuropsychology , Great Ormond Street Hospital for Children NHS Foundation Trust , London , United Kingdom
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Yilmaz A, Kizilay Z, Ozkul A, Çirak B. Pure Motor Stroke Secondary to Cerebral Infarction of Recurrent Artery of Heubner after Mild Head Trauma: A Case Report. Open Access Maced J Med Sci 2016; 4:139-41. [PMID: 27275348 PMCID: PMC4884235 DOI: 10.3889/oamjms.2016.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/18/2015] [Accepted: 12/19/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The recurrent Heubner's artery is the distal part of the medial striate artery. Occlusion of the recurrent artery of Heubner, classically contralateral hemiparesis with fasciobrachiocrural predominance, is attributed to the occlusion of the recurrent artery of Heubner and is widely known as a stroke syndrome in adults. However, isolated occlusion of the deep perforating arteries following mild head trauma also occurs extremely rarely in childhood. CASE REPORT Here we report the case of an 11-year-old boy with pure motor stroke. The brain MRI showed an acute ischemia in the recurrent artery of Heubner supply area following mild head trauma. His fasciobrachial hemiparesis and dysarthria were thought to be secondary to the stretching of deep perforating arteries leading to occlusion of the recurrent artery of Heubner. CONCLUSION Post-traumatic pure motor ischemic stroke can be secondary to stretching of the deep perforating arteries especially in childhood.
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Affiliation(s)
- Ali Yilmaz
- Adnan Menderes University, Faculty of Medicine, Neurosurgery Department, Aydin, Turkey
| | - Zahir Kizilay
- Adnan Menderes University, Faculty of Medicine, Neurosurgery Department, Aydin, Turkey
| | - Ayca Ozkul
- Adnan Menders University, Faculty of Medicine, Department of Neurology, Aydin, Turkey
| | - Bayram Çirak
- Pamukkale University, Faculty of Medicine, Department of Neurosurgery, Denizli, Turkey
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25
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Bernard TJ, Friedman NR, Stence NV, Jones W, Ichord R, Amlie-Lefond C, Dowling MM, Rivkin MJ. Preparing for a "Pediatric Stroke Alert". Pediatr Neurol 2016; 56:18-24. [PMID: 26969238 DOI: 10.1016/j.pediatrneurol.2015.10.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/06/2015] [Accepted: 10/13/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Childhood arterial ischemic stroke is an important cause of morbidity and mortality in children. Hyperacute treatment strategies remain controversial and challenging, especially in the setting of increasingly proven medical and endovascular options in adults. Although national and international pediatric guidelines have given initial direction about acute therapy and management, pediatric centers have traditionally lacked the infrastructure to triage, diagnose, and treat childhood arterial ischemic stroke quickly. METHODS In the past 10 years, researchers in the International Pediatric Stroke Study and Thrombolysis in Pediatric Stroke study have initiated early strategies for establishing pediatric specific stroke alerts. RESULTS We review the rationale, process and components necessary for establishing a pediatric stroke alert. CONCLUSION Development of pediatric stroke protocols and pathways, with evidence-based acute management strategies and supportive care where possible, facilitates the evaluation, management, and treatment of an acute pediatric stroke.
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Affiliation(s)
- Timothy J Bernard
- Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Aurora, Colorado; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
| | - Neil R Friedman
- Center for Pediatric Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nicholas V Stence
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - William Jones
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Rebecca Ichord
- Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Catherine Amlie-Lefond
- Seattle Children's Hospital, Department of Neurology, University of Washington, Seattle, Washington
| | - Michael M Dowling
- Division of Pediatric Neurology, Department of Pediatrics and Neurology, University of Texas Southwestern Medical Center Dallas, Dallas, Texas
| | - Michael J Rivkin
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; Department of Radiology, Boston Children's Hospital, Boston, Massachusetts; Department of Neurology, Harvard Medical School, Boston, Massachusetts
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26
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Abstract
Emergency physicians are often the first point of contact in children presenting with acute neurological disorders. Differentiating serious disorders, such as stroke, from benign disorders, such as migraine, can be challenging. Clinical assessment influences decision-making, in particular the need for emergent neuroimaging to confirm diagnosis. This review describes the spectrum of disorders causing 'brain attack' symptoms, or acute onset focal neurological dysfunction, with particular emphasis on childhood stroke, because early recognition is essential to improve access to thrombolytic treatments, which have improved outcomes in adults. Clues to diagnosis of specific conditions are discussed. Symptoms and signs, which discriminate stroke from mimics, are described, highlighting differences to adults. Haemorrhagic and ischaemic stroke have different presenting features, which influence choice of the most appropriate imaging modality to maximise diagnostic accuracy. Improvements in the care of children with brain attacks require coordinated approaches and system improvements similar to those developed in adults.
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Affiliation(s)
- Mark T Mackay
- Department of Neurology.,Murdoch Childrens Research Institute, Parkville, Australia.,Florey Institute of Neurosciences and Mental Health.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Monagle
- Murdoch Childrens Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Franz E Babl
- Emergency Department, Royal Children's Hospital.,Murdoch Childrens Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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27
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Abstract
Childhood primary angiitis of the central nervous system (cPACNS) is a rare and a potentially fatal cause of childhood stroke. The disease poses a diagnostic dilemma for the clinicians due to overlapping and varied clinical manifestations such as headache, focal acute neurological deficits, cognitive impairment, or encephalopathy. We report a young boy who presented with low-grade fever and headache but rapidly progressed to develop acute encephalopathy and quadriparesis with multiple cranial nerve palsies, masquerading as acute disseminated encephalomyelitis. The neuroimaging was suggestive of vasculitis. He was diagnosed as cPACNS and recovered with immunosuppressive therapy.
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Affiliation(s)
- Aashima Dabas
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Sangeeta Yadav
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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28
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Smith SE, Vargas G, Cucchiara AJ, Zelonis SJ, Beslow LA. Hemiparesis and epilepsy are associated with worse reported health status following unilateral stroke in children. Pediatr Neurol 2015; 52:428-34. [PMID: 25559938 PMCID: PMC4556437 DOI: 10.1016/j.pediatrneurol.2014.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/26/2014] [Accepted: 11/28/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Perinatal and childhood stroke result in neurological impairment in the majority of survivors, but less is known about patient and parent perception of function following stroke in children. Our aim was to characterize parent-proxy and child-reported health status in children following unilateral arterial ischemic stroke or intraparenchymal hemorrhage. METHODS Fifty-nine children 2-18 years (30 girls, 29 boys) with unilateral arterial ischemic stroke or spontaneous intraparenchymal hemorrhage at least 6 months before evaluation were enrolled from a single center. The PedsQL version 4.0 Generic Short Form and PedsQL version 3.0 Cerebral Palsy Module were administered to childhood stroke subjects and parents. Generic PedsQL Inventory scores were compared between children with stroke and published data from healthy children. Reported health status scores for children with varying degrees of hemiparesis were compared. RESULTS Children with stroke had lower reported health status scores on the Generic PedsQL Inventory than healthy children. Children with moderate-severe hemiparesis had worse scores than children without hemiparesis on several measures of the Cerebral Palsy Module as reported by both parents and children. The parents of children with epilepsy reported worse scores on several measures compared with children without epilepsy, and the parent scores were lower on several measures for children with lower intelligence quotients. Agreement between parent and child scores was better on the Cerebral Palsy Module than on the Generic Inventory. CONCLUSIONS Children with stroke have worse reported health status than healthy controls. Degree of hemiparesis, epilepsy, and lower intelligence quotient affect reported health status on some measures. Agreement between parent-proxy and child scores ranges from slight to good which suggests that both provide useful information.
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Affiliation(s)
- Sabrina E. Smith
- Department of Neurology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Division of Pediatric Neurology, Kaiser Permanente Oakland Medical Center, Oakland, California,Communications should be addressed to: Dr. Sabrina E. Smith; Division of Pediatric Neurology; Kaiser Permanente Oakland Medical Center; 275 W. MacArthur Blvd.; Oakland; CA 94611.
| | - Gray Vargas
- Department of Neurology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Department of Psychology, Penn State University, University Park, Pennsylvania
| | - Andrew J. Cucchiara
- Clinical and Translational Research Center, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah J. Zelonis
- Department of Neurology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lauren A. Beslow
- Department of Neurology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut,Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
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29
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Gelfand AA, Fullerton HJ, Jacobson A, Sidney S, Goadsby PJ, Kurth T, Pressman A. Is migraine a risk factor for pediatric stroke? Cephalalgia 2015; 35:1252-60. [PMID: 25754176 DOI: 10.1177/0333102415576222] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/13/2015] [Indexed: 11/17/2022]
Abstract
IMPORTANCE Our understanding of risk factors for childhood stroke is incomplete. In adults, migraine with aura is associated with a two-fold increase in ischemic stroke risk. OBJECTIVE In this cohort study we examine the association between migraine and stroke among children in Kaiser Permanente Northern California (KPNC). DESIGN, SETTING, AND PARTICIPANTS Children ages 2-17 years who were members of KPNC for ≥6 months between 1997 and 2007 were included. Migraine cohort members had one or more of: an ICD-9 code for migraine, migraine listed as a significant health problem, or a prescription for a migraine-specific medication. The comparison group was children with no evidence of headache. MAIN OUTCOME MEASURES Main outcome measures included stroke incidence rates and incidence rate ratios (IR). RESULTS Among the 1,566,952 children within KPNC during the study period, 88,164 had migraine, and 1,323,142 had no evidence of headache. Eight migraineurs had a stroke (three (38%) hemorrhagic; five (63%) ischemic). Eighty strokes occurred in children without headache (53 (66%) hemorrhagic; 27 (34%) ischemic). The ischemic stroke incidence rate was 0.9/100,000 person-years in migraineurs vs. 0.4/100,000 person-years in those without headache; IR 2.0 (95% CI 0.8-5.2). A post-hoc analysis of adolescents (12-17 years) showed an increased risk of ischemic stroke among those with migraine; IR 3.4 (95% CI 1.2-9.5). The hemorrhagic stroke incidence rate was 0.5/100,000 person-years in migraineurs and 0.9/100,000 person-years in those without headache; IR 0.6 (95% CI 0.2-2.0). CONCLUSIONS There was no statistically significant increase in hemorrhagic or ischemic stroke risk in pediatric migraineurs in this cohort study. A post-hoc analysis found that ischemic stroke risk was significantly elevated in adolescents with migraine. Future studies should focus on identifying risk factors for ischemic stroke among adolescent migraineurs. Based on adult data, we recommend that migraine aura status should be studied as a possible risk factor for ischemic stroke among adolescent migraineurs.
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Affiliation(s)
- Amy A Gelfand
- UCSF Headache Center, Department of Neurology, University of California San Francisco, USA Division of Child Neurology, UCSF, USA
| | | | - Alice Jacobson
- Sutter Health Research Development and Dissemination, USA Kaiser Permanente Northern California, Division of Research Oakland, USA
| | - Stephen Sidney
- Kaiser Permanente Northern California, Division of Research Oakland, USA
| | - Peter J Goadsby
- UCSF Headache Center, Department of Neurology, University of California San Francisco, USA NIHR-Wellcome Trust Clinical Research Facility, King's College London, UK
| | - Tobias Kurth
- Inserm Research Center for Epidemiology and Biostatistics (U897) - Team Neuroepidemiology, France University of Bordeaux, College of Health Sciences, France
| | - Alice Pressman
- Sutter Health Research Development and Dissemination, USA Kaiser Permanente Northern California, Division of Research Oakland, USA
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30
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Abstract
There are scarce reports of childhood stroke from China. Our objective was to describe the clinical spectrum, risk factors, and imaging characteristics of childhood stroke in China. Using a hospital discharge database, children with stroke who were first admitted from 2002 to 2011 were retrospectively enrolled. We identified 478 first admissions with childhood stroke, including 229 cases of ischemic stroke and 249 hemorrhagic stroke. Boys accounted for more than 60% in all stroke types (62.2% for ischemic stroke, intracerebral hemorrhage for 66.2%). The leading cause was moyamoya for ischemic stroke and arteriovenous malformations for intracerebral hemorrhage. Hemiplegia and headache were the most common presenting features. Internal carotid artery and middle cerebral artery were the most involved arteries according to imaging examination in the ischemic stroke. A total of 8 patients died of intracerebral hemorrhage. The prevalence of hemorrhagic stroke was more than that of ischemic stroke. As Western countries, arteriopathy was the most common cause of childhood stroke.
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Affiliation(s)
- Yaxian Deng
- Department of Pediatrics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Weili Yang
- Department of Pediatrics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yazhen Yu
- Department of Pediatrics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Juanyu Xu
- Department of Pediatrics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baoqin Gao
- Department of Pediatrics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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31
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Sultan SM, Beslow LA, Vossough A, Elkind MSV, Kasner SE, Mirsky DM, Licht DJ, Ichord RN. Predictive validity of severity grading for cerebral steno-occlusive arteriopathy in recurrent childhood ischemic stroke. Int J Stroke 2014; 10:213-8. [PMID: 25104397 DOI: 10.1111/ijs.12344] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 06/12/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cerebral arteriopathy is a risk factor for incident and recurrent childhood AIS. There are no standardized criteria to quantify arteriopathy severity. AIMS To evaluate a method of scoring severity of steno-occlusive arteriopathy in childhood arterial ischemic stroke (AIS) and its association with recurrence. METHODS In a single-center prospectively enrolled cohort of 49 children with first AIS and arteriopathy, a composite cerebrovascular stenosis score (CVSS) was measured by two independent raters as the sum of stenosis scores in each of 18 intracranial large and medium arteries, where 0 = none; 1 = low-grade, 1-50%; 2 = high-grade, >50-99%; 3 = occlusion, 100%. Cox proportional-hazards models were used to determine the association of CVSS with recurrence. The analysis was stratified by presence or absence of moyamoya arteriopathy (syndrome or disease). RESULTS At a median follow-up period of 2.5 years (range: 0.8-9), 18/49 children (37%) experienced a recurrence. Median time to recurrence was 0.2 (range: 0.02-2.8) years. Interrater agreement was good, with an intraclass correlation coefficient of 0.77 [95% confidence interval (CI) 0.63-0.87, P < 0.001). Higher CVSS was associated with higher recurrence rate [hazard ratio (HR) per point 1.09, 95% CI 1.04-1.16, P = 0.001]. Among those with moyamoya arteriopathy, CVSS was associated with recurrence (HR per point of CVSS 1.11, 95% CI 1.03-1.19, P = 0.004), but there was no association in those without moyamoya arteriopathy (HR per point of CVSS 0.91, 95% CI 0.75-1.09, P = 0.32). CONCLUSIONS The CVSS is a reliable measure of severity of steno-occlusive arteriopathy in childhood stroke. This preliminary study suggests that higher CVSS is associated with stroke recurrence in children with moyamoya arteriopathy.
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Affiliation(s)
- Sally M Sultan
- Department of Neurology, Neurological Institute of New York, Columbia University Medical Center, New York, NY, USA
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32
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Ilves P, Tomberg T, Kepler J, Laugesaar R, Kaldoja ML, Kepler K, Kolk A. Different plasticity patterns of language function in children with perinatal and childhood stroke. J Child Neurol 2014; 29:756-64. [PMID: 23748202 PMCID: PMC4230975 DOI: 10.1177/0883073813489350] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 04/12/2013] [Indexed: 11/16/2022]
Abstract
Plasticity of language function after brain damage can depend on maturation of the brain. Children with left-hemisphere perinatal (n = 7) or childhood stroke (n = 5) and 12 controls were investigated using functional magnetic resonance imaging. The verb generation and the sentence comprehension tasks were employed to activate the expressive and receptive language areas, respectively. Weighted laterality indices were calculated and correlated with results assessed by neuropsychological test battery. Compared to controls, children with childhood stroke showed significantly lower mean scores for the expressive (P < .05) and receptive (P = .05) language tests. On functional magnetic resonance imaging they showed left-side cortical activation, as did controls. Perinatal stroke patients showed atypical right-side or bilateral language lateralization during both tasks. Negative correlation for stroke patients was found between scores for expressive language tests and laterality index during the verb generation task. (Re)organization of language function differs in children with perinatal and childhood stroke and correlates with neurocognitive performance.
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Affiliation(s)
- Pilvi Ilves
- Radiology Clinic of Tartu University Hospital, Department of Radiology, University of Tartu, Tartu, Estonia
| | - Tiiu Tomberg
- Radiology Clinic of Tartu University Hospital and Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | | | - Rael Laugesaar
- Department of Neurology and Neurorehabilitation, University of Tartu and Children’s Clinic of Tartu University Hospital, Tartu, Estonia
| | | | - Kalle Kepler
- Institute of Physics, University of Tartu, Tartu, Estonia
| | - Anneli Kolk
- Department of Neurology and Neurorehabilitation, University of Tartu and Children’s Clinic of Tartu University Hospital, Tartu, Estonia
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33
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Sultan SM, Schupf N, Dowling MM, Deveber GA, Kirton A, Elkind MSV. Review of lipid and lipoprotein(a) abnormalities in childhood arterial ischemic stroke. Int J Stroke 2013; 9:79-87. [PMID: 24148253 DOI: 10.1111/ijs.12136] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
National organizations recommend cholesterol screening in children to prevent vascular disease in adulthood. There are currently no recommendations for cholesterol and lipoprotein (a) testing in children who experience an arterial ischemic stroke. While dyslipidemia and elevated lipoprotein (a) are associated with ischemic stroke in adults, the role of atherosclerotic risk factors in childhood arterial ischemic stroke is not known. A review of the literature was performed from 1966 to April 2012 to evaluate the association between childhood arterial ischemic stroke and dyslipidemia or elevated lipoprotein (a). Of 239 citations, there were 16 original observational studies in children (with or without neonates) with imaging-confirmed arterial ischemic stroke and data on cholesterol or lipoprotein (a) values. Three pairs of studies reported overlapping subjects, and two were eliminated. Among 14 studies, there were data on cholesterol in 7 and lipoprotein (a) in 10. After stroke, testing was performed at >three-months in nine studies, at ≤three-months in four studies, and not specified in one study. There were five case-control studies: four compared elevated lipoprotein (a) and one compared abnormal cholesterol in children with arterial ischemic stroke to controls. A consistent positive association between elevated lipoprotein (a) and stroke was found [Mantel-Haenszel OR 4·24 (2·94-6·11)]. There was no association in one study on total cholesterol, and a positive association in one study on triglycerides. The literature suggests that elevated lipoprotein (a) may be more likely in children with arterial ischemic stroke than in control children. The absence of confirmatory study on dyslipidemia should be addressed with future research.
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Affiliation(s)
- Sally M Sultan
- Neurologic Institute, Department of Neurology, Columbia University Medical Center, New York, NY, USA
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Abstract
Pediatric neurocritical care is an emerging multidisciplinary field of medicine and a new frontier in pediatric critical care and pediatric neurology. Central to pediatric neurocritical care is the goal of improving outcomes in critically ill pediatric patients with neurological illness or injury and limiting secondary brain injury through optimal critical care delivery and the support of brain function. There is a pressing need for evidence based guidelines in pediatric neurocritical care, notably in pediatric traumatic brain injury and pediatric stroke. These diseases have distinct clinical and pathophysiological features that distinguish them from their adult counterparts and prevent the direct translation of the adult experience to pediatric patients. Increased attention is also being paid to the broader application of neuromonitoring and neuroprotective strategies in the pediatric intensive care unit, in both primary neurological and primary non-neurological disease states. Although much can be learned from the adult experience, there are important differences in the critically ill pediatric population and in the circumstances that surround the emergence of neurocritical care in pediatrics.
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Affiliation(s)
- Sarah Murphy
- MassGeneral Hospital for Children, Boston, MA 02114, USA.
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35
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Abstract
Cerebrovascular complications are being frequently recognized in the pediatric intensive care unit in the recent few years. The epidemiology and risk factors for pediatric stroke are different from that of the adults. The incidence of ischemic stroke is almost slightly more than that of hemorrhagic stroke. The list of diagnostic causes is increasing with the availability of newer imaging modalities and laboratory tests. The diagnostic work up depends on the age of the child and the rapidity of presentation. Magnetic resonance imaging, computerized tomography and arteriography and venography are the mainstay of diagnosis and to differentiate between ischemic and hemorrhagic events. Very sophisticated molecular diagnostic tests are required in a very few patients. There are very few pediatric studies on the management of stroke. General supportive management is as important as the specific treatment. Most of the treatment guidelines and suggestions are extrapolated from the adult studies. Few guidelines are available for the use of anticoagulants and thrombolytic agents in pediatric patients. So, our objective was to review the available literature on the childhood stroke and to provide an insight into the subject for the pediatricians and critical care providers.
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Affiliation(s)
- Anil Sachdev
- From: Department of Pediatrics, Sir Ganga Ram Hospital, New Rajinder Nagar, New Delhi, India
| | - Rachna Sharma
- Department of Pediatrics, Dr. B. L. Kapoor Memorial Hospital, Pusa Road, New Delhi, India
| | - Dhiren Gupta
- From: Department of Pediatrics, Sir Ganga Ram Hospital, New Rajinder Nagar, New Delhi, India
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