A Clinical Approach to Arterial Ischemic Childhood Stroke: Increasing Knowledge over the Last Decade

Abstract

Childhood stroke is increasingly being recognized as an important burden not only for affected children and families, but also for socioeconomic reasons. A primary problem is delayed diagnosis, due to the many mimics of childhood stroke, and the variety of manifesting symptoms. The most important is hemiparesis (with/without dysphasia or facial palsy), but ataxia, seizures, and many more are also possible. Suspicion of stroke has to be ascertained by neuroimaging, gold standard being (diffusion weighted) magnetic resonance. Risk factors are multiple, but their presence might help to increase the suspicion of stroke. The most important factors are infectious/parainfectious etiologies, frequently possibly manifesting by transient focal cerebral arteriopathy (FCA). Cardiological underlying problems are the second most important. Arteriopathies can be detected in about half of the children, besides FCA and dissection and MoyaMoya disease are the most important. Hereditary coagulopathies increase the risk of stroke. There is still a controversy on best treatment in children: platelet antiaggregation and heparinization are used about equally. Thrombolysis is being discussed increasingly. Severity of symptoms at manifestation and on follow-up are not less significant in children than in young adults. About two-third of the children have significant residual neurological problems and a majority cognitive and behavior problems.

Acute Encephalopathy with Unilateral Cortical-Subcortical Lesions in Two Unrelated Kindreds Treated with Glucocorticoids Prenatally for Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency: Established Facts and Novel Insight

“…An acute arterial ischemic stroke (AIS) resulting from a focal interruption of the cerebral blood supply caused by vascular pathology or embolism may lead to focal lesions in the brain. In children, AIS is seen in 2-5/100,000 children per year with a boy to girl ratio of 2:1 [23,24,25]. Known risk factors include infectious, parainfectious reactions, vasculopathies, systemic disorders, heart defects and hereditary coagulopathies [26].…”

“…CAH or prenatal glucocorticoid treatment has not been reported as a risk factor for cerebrovascular disease in children [24,25,26]. Similarly, no CAH patient suffering from cerebrovascular events has been reported so far.…”

Stroke in children and adolescents: a formation of a pediatric register

“…Как отмечают исследователи, именно в случаях дет-ского инсульта нередко удается установить сочетание не-скольких этиологических факторов, которые приводят к его развитию [5,14]. Вклад каждого из этих факторов и их комбинации у конкретного ребенка могут отличаться, что зависит от перинатального анамнеза, преморбидного фо-на и сопутствующих заболеваний, семейных и генетиче-ских особенностей.…”

Pediatric Stroke and Seizures

“…Chronic neurological morbidity including sensorimotor, cognitive, and behavioral problems are expected in up to three quarters of children after stroke [9]. Although motor deficits are the most apparent disabilities, seizures, neurocognitive disabilities, and behavior problems play a crucial role in long-term outcome [93].…”