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

Margherita Rosa,Silvia Romanello,Silvana De Lucia,Claudio Veropalumbo,Luigi Titomanlio,Julie Le Gal,Marie Desmarest,Victoria Elisa Rinaldi

doi:10.1186/s13052-015-0174-y

Abstract

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

Highlights

Stroke is defined as a sudden loss of brain function caused by a decreased cerebral blood flow
Perinatal stroke differs from paediatric stroke in some clinical and pathophysiological aspects, mainly overlapping with global hypoxic ischemic encephalopathy and presenting with more aspecific and generalised signs such as apnea, hypotonia, poor feeding, seizures and irritability [7,8,9,10,11]
In this review we have tried to focus on risk factors and underlying mechanisms, diagnosis, treatment, Rosa et al Italian Journal of Pediatrics (2015) 41:95 rehabilitation, knowledge translation and knowledge needs about paediatric arterial ischemic stroke (AIS)

Summary

Background

Stroke is defined as a sudden loss of brain function caused by a decreased cerebral blood flow. Conscious of the limitations in classifying arteriopathies on initial imaging, the IPSS has recently suggested the term “focal cerebral arteriopathy” of childhood (FCA) to describe children with an unilateral arterial stenosis without an apparent underlying cause at presentation These arteriopathies are clinically important because their presence indicates an increased risk for recurrent stroke and vascular imaging of intracranial and neck vessels are imperative to detect them. Preliminary studies suggest that anticoagulation may be safe in children with AIS (even in those with arteriopathy), the need of a randomised clinical trial to establish the optimum antithrombotic treatment of paediatric stroke and its secondary prevention persists. These techniques have been defined as relatively safe, with a maximum benefit when performed in crucial periods of early development and with hopeful improvements in motor long-term follow-up [87,88,89,90,91,92,93,94,95,96,97,98,99]

Conclusions

Findings

35. Royal College of Physicians Paediatric Stroke Working Group