From the Guidelines
Rapid stroke evaluation in children requires immediate recognition of symptoms and activation of emergency services, with a pediatric-specific stroke protocol that includes rapid neuroimaging, preferably with MRI, within 60 minutes of arrival, as recommended by the most recent guidelines 1. When a child presents with sudden neurological deficits, healthcare providers should follow this protocol to ensure timely and appropriate care. The initial assessment should include the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) to quantify deficits, as well as laboratory tests such as complete blood count, coagulation studies, and metabolic panel. Some key points to consider in the approach to acute stroke evaluation in pediatric patients include:
- The importance of rapid neuroimaging, preferably with MRI, within 60 minutes of arrival 1
- The use of standardized, valid assessment tools to evaluate the patient's stroke-related impairments and functional status, such as the PedNIHSS 1
- The consideration of age-appropriate diagnostic workup, given the different etiologies of pediatric strokes, including congenital heart disease, arteriopathies, and hematologic disorders 1
- The potential benefits of reperfusion therapies, including tissue plasminogen activator (tPA) and mechanical thrombectomy, in pediatric patients with confirmed ischemic stroke 1
- The importance of early neurology and neurointerventional consultation, as well as rapid transfer to a pediatric stroke center when available, to ensure optimal care and outcomes 1
From the Research
Approach to Acute Stroke Evaluation in Pediatric Patients
The approach to acute stroke evaluation in pediatric patients involves several key steps, including:
- Prompt identification and diagnosis, as delays can lead to significant morbidity and mortality 2, 3
- Neuroimaging to confirm diagnosis and define the extent of the stroke 3, 4
- Consideration of recanalization therapies, such as intravenous tissue plasminogen activator (tPA) or mechanical thrombectomy, although the evidence for these treatments in pediatric patients is limited 2, 5
- Implementation of neuroprotective measures to minimize damage and improve outcomes 5, 4
- Attention to secondary prevention, including determining the underlying stroke etiology and tailoring management strategies accordingly 4
Key Considerations
- Pediatric stroke is a heterogeneous condition with diverse etiologies, and management strategies must be individualized 4
- The clinical presentation of stroke in children can be subtle and nonspecific, making diagnosis challenging 3, 6
- Emergency department physicians play a critical role in recognizing common presenting features and risk factors for pediatric stroke 6
- Dedicated pediatric stroke centers and care pathways can improve outcomes and provide specialized care for children with acute stroke 5, 4