From the Guidelines
Pediatric stroke is a rare but serious condition where blood flow to a part of the brain is interrupted, causing brain tissue damage, and it is crucial to seek emergency medical attention immediately if suspected, as prompt treatment significantly improves outcomes. According to the most recent guidelines, pediatric stroke can occur in both newborns (perinatal stroke) and older children, with causes differing from adult strokes, including congenital heart defects, blood disorders like sickle cell disease, infections, vascular abnormalities, and genetic conditions 1. The signs of pediatric stroke include sudden weakness or numbness (especially on one side), difficulty speaking, severe headache, vision problems, loss of balance, and seizures, with symptoms in infants being subtle, such as favoring one side of the body or seizures affecting only one side 1.
Key Considerations
- Diagnosis typically involves brain imaging like MRI or CT scans, along with blood tests and heart evaluations 1.
- Treatment depends on the cause but may include blood thinners like aspirin or heparin in acute cases, supportive care, and addressing underlying conditions.
- Rehabilitation is crucial and may involve physical, occupational, and speech therapy, with a focus on "new" learning (habilitation) rather than relearning (rehabilitation) depending on age at time of stroke 1.
- Recovery potential is generally better in children than adults due to brain plasticity, but long-term effects can include learning difficulties, physical disabilities, seizures, or behavioral problems.
Importance of Prompt Treatment
Early identification of stroke in children is important because a shorter time to definitive therapy decreases the risk of death and permanent disability from stroke, and shortening the time from presentation in the first aid setting to an ED, preferably with pediatric neurology and stroke expertise, is an important component of this timeline 1. It is essential to prioritize prompt medical attention if pediatric stroke is suspected, as timely treatment can significantly improve outcomes and reduce the risk of long-term effects.
From the Research
Definition and Overview of Pediatric Stroke
- Pediatric stroke is a leading cause of morbidity and mortality in children, resulting in significant lifelong neurological disability 2, 3
- It is a rare occurrence in children, with an incidence rate of 1/3500 live birth in newborns and 1-2/100,000 per year during childhood 4
- The diagnosis of stroke is often delayed in children, which can contribute to death and disability 3
Causes and Risk Factors
- The causes of pediatric arterial ischemic stroke are unique compared to those associated with stroke in adulthood 5
- Multiple factors are commonly identified as the cause of stroke in children, and stroke can be prevented in some children and treated in others 6
- Pleomorphic age-dependent risk factors and aetiologies are involved in the management of ischemic stroke in the pediatric age 4
Treatment and Management
- The mainstay of pediatric stroke treatment relies on rehabilitation to improve outcomes, as most patients are ineligible for hyperacute recanalization therapies 2
- Management of pediatric stroke is challenging due to the lack of evidence-based data on acute recanalization therapies, and treatment is often based on society guidelines and expert opinion 3, 4
- Recent studies have shown that thrombolysis and endovascular treatments may be effective in children, with a low risk of intracranial hemorrhages 4, 5