The Pediatric Stroke Code: Early Management of the Child with Stroke

Abstract

troke in children is estimated to occur as frequently as brain tumors, and acute presentations should be considered a neurologic emergency. Although stroke is less common in children than in adults, the long-term morbidity and societal impact of stroke in children likely exceeds that in adults. Lessons from adult stroke trials underscore the need for early therapy to prevent complications and improve outcomes. In children, the prompt diagnosis of stroke is challenging, and a delay in diagnosis is a major impediment to initiating therapy. Subspecialty services required for emergent diagnosis and management of pediatric stroke are available at most academic medical centers. Although guidelines for the management of stroke in children exist, care varies by institution, and interventions to minimize morbidity and prevent complications are often applied inconsistently. Herein we propose the “pediatric stroke code,” a systematic, multidisciplinary approach to early management of the child with stroke, including hospital preparedness, timely diagnosis, hyperacute therapy, supportive care, management of complications, and secondary stroke prevention. The recommendations discussed are for children and are not applicable to neonates. Neonatal stroke is differentiated from childhood stroke based on differences in etiology, risk factors, and presentation.