Pediatric Patient with Ischemic Stroke: Initial Approach and Early Management.

Tereza Musilová,Milan Kratochvíl,Tamara Skříšovská,Eva Klabusayová,Petr Jabandžiev,Ondřej Horák,Petr Štourač,Martina Kosinová,Jozef Klučka,Hana Ošlejšková,Tereza Kramplová

doi:10.3390/children8080649

Tereza Musilová, Milan Kratochvíl + Show 9 more

Open Access

https://doi.org/10.3390/children8080649

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Abstract

Acute Ischemic Stroke (AIS) in children is an acute neurologic emergency associated with significant morbidity and mortality. Although the incidence of AIS in pediatric patients is considerably lower than in adults, the overall cumulative negative impact of the quality of life could be even higher in children. The age-related variable clinical presentation could result in a delay in diagnosis and could negatively influence the overall outcome. The early management should be based on early recognition, acute transfer to pediatric AIS centre, standardised approach (ABCDE), early neurologic examination together with neuroimaging (preferable Magnetic Resonance Imaging—MRI). The treatment is based on supportive therapy (normoxemia, normocapnia, normotension and normoglycemia) in combination with intravenous/intraarterial thrombolytic therapy and/or mechanical thrombectomy in selected cases. Pediatric stroke centres, together with the implementation of local stroke management protocols, could further improve the outcome of pediatric patients with AIS.

Highlights

According to the World Health Organization (WHO), a stroke is defined as “rapidly developing clinical signs of focal disturbance of cerebral function, with symptoms lasting 24 h or longer or resulting in death, with no apparent cause other than of vascular origin” [1]
The reported incidence of strokes in pediatric patients is between 1.3–13/100,000/year and up to 25–40/100,000/births in neonates [15,17,18,19] with an increasing trend over the past decades that is possibly due to the improvement in stroke detection and availability of imaging methods [20]
Pathogenesis of pediatric Acute Ischemic Stroke (AIS) seems to be different from adults in which atherosclerosis, diabetes mellitus, hypertension, smoking, metabolic syndrome, insulin resistance and chronic inflammatory conditions are well recognised risk factors [13]

Summary

Introduction

According to the World Health Organization (WHO), a stroke is defined as “rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 h or longer or resulting in death, with no apparent cause other than of vascular origin” [1]. The proportion of patients with lasting neurologic deficit [7,8,9,10], the impact on quality of life and the health care system and overall cumulative care costs could be significantly higher in children [9,11,12]. This narrative review aims to primarily investigate AIS in pediatric patients

Classification

Epidemiology

Risk Factors

Presentation and Diagnosis

Initial Approach

Aim

Imaging

Specific AIS Therapy

Further Treatment and Recurrence Prevention

10. Outcome

Findings

11. Conclusions