Pediatric Acute Stroke Protocols in the United States and Canada

Harrar, Dana; Benedetti, Giulia M.; Jayakar, Anuj; Carpenter, Jessica; Mangum, Tara; Chung, Melissa G.; Appavu, Brian

doi:10.1016/j.jpeds.2021.10.048

Cited by 21 publications

(17 citation statements)

References 46 publications

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“…In the present study, we found that CT was the favorable initial imaging modality. However, a pediatric stroke specialist survey-based study by Harrar et al 16 in the United States and Canada revealed that most institutions preferred MRI over CT and used abbreviated MRI protocols for pediatric acute stroke imaging. A neuroimaging-based core-penumbra approach must recognize the incapability of children under mechanical circulatory support to endure MRI.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Stroke from Bench to Bedside: A Single-Center Experience in Saudi Arabia

Al-Sharydah

Al-Arfaj

Al-Suhibani

et al. 2022

VHRM

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Purpose Stroke is a leading cause of severe long-term disability and death worldwide. This study aimed to determine the genetic background, causative factors, and diagnostic and outcome measures of pediatric stroke in an area endemic to sickle cell disease (SCD). Patients and Methods This retrospective review analyzed pediatric patients with acute stroke who were admitted to King Fahd Hospital of the University, Eastern Province, Saudi Arabia, between January and June 2019. We assessed 49 cases based on computed tomography (CT) and magnetic resonance imaging (MRI) findings. Patients with incomplete records or unavailable radiological images were excluded. Results A high likelihood of familial coexistence of stroke was detected in patients with affected siblings (33%). Among various central nervous system manifestations, motor weakness (28.6%) and headache (20.4%) were the most common symptoms/signs. Hypoxic-ischemic encephalopathy (HIE) (28.6%), SCD (22.5%), and moyamoya disease (14.3%) were the most prevalent underlying etiologies. CT without intravenous contrast was the most used initial imaging technique (92.5%). An arterial blockage was more prevalent (53.4%) than a venous infarct (46.6%) (p = 0.041), while arterial ischemic stroke was more prevalent (56.5%) than hemorrhagic stroke (43.5%). The middle cerebral artery (MCA) was most affected (63.5%), followed by the anterior cerebral artery (22.7%) and posterior cerebral artery (13.6%). Most patients were managed with medical treatment (86.1%). No mortalities occurred during the initial hospital stay. The mean length of hospital stay was 12 days. Conclusion HIE was the most prevalent etiology of pediatric stroke. Motor weakness and headache were the most common initial manifestations. Arterial ischemic stroke was more prevalent than venous or hemorrhagic stroke. Considering the rarity of pediatric stroke, future studies should be performed with a aborative effort nationally and internationally.

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Section: Discussionmentioning

confidence: 99%

Pediatric Stroke from Bench to Bedside: A Single-Center Experience in Saudi Arabia

Al-Sharydah

Al-Arfaj

Al-Suhibani

et al. 2022

VHRM

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“…The 2008 AHA pediatric stroke guidelines recommended against IV tPA use in children with the possible exception of adolescents who otherwise meet adult criteria [ 22 ]. Nonetheless, IV tPA does not appear to be less safe in children than in adults [ 23 ], and most tertiary pediatric hospitals in the United States have protocols for use of IV tPA in children with acute stroke [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Pediatric Stroke due to Thoracic Outlet Syndrome Treated with Thrombolysis and Thrombectomy: A Case Report

et al. 2022

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Thoracic outlet syndrome (TOS) is a condition that results from the compression of neurovascular structures as they exit the thorax. Arterial ischemic stroke can occur in TOS due to retrograde embolism from the subclavian artery. We describe a 15-year-old girl who presented with left hemiplegia after 2 weeks of right arm numbness and tingling. Imaging showed an acute ischemic stroke due to a right middle cerebral artery occlusion. She was treated with intravenous tissue plasminogen activator at 1.3 h and mechanical thrombectomy at 2.4 h with successful recanalization. Review of her neck computed tomography angiogram suggested a right subclavian artery aneurysm, and upper-extremity imaging also demonstrated distal thrombosis and fusion of right first and second ribs, which was consistent with thoracic outlet syndrome. Three days later, she underwent a right subclavian artery aneurysm repair, right brachial and ulnar artery thrombectomy, and first rib resection. Three months later, she demonstrated good neurologic recovery. TOS is an uncommon cause of stroke in children, which may be heralded by upper-extremity symptoms. Interventionalists should be aware of the possibility of vascular anomalies in children; however, this finding does not exclude the possibility of acute stroke intervention.

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“…Hypoperfusion on perfusion-based imaging more accurately identifies delayed cerebral ischemia than arterial narrowing on CTA or MRA or an increase in MFV on TCD. 71,85,86 Although useful in assessing the potential impact of vasospasm, CT perfusion is not universally available in pediatric institutions 87 and is associated with contrast and high radiation exposure, making it a less-than-ideal modality for serial monitoring of vasospasm, especially in children.…”

Section: Methodsmentioning

confidence: 99%

“…While we have highlighted the utility of DSA in the diagnosis and management of critically ill children with ICH, its availability, risks, and costs are important limitations to its use. Many pediatric institutions rely on the neurointerventional capabilities of a partner adult hospital for urgent or emergent catheter angiography 87,95 as pediatric neuroangiography training and experience are limited. 10 Regarding risks, diagnostic cerebral angiography is a safe procedure with expected and reported low complication rates, 10 including vessel injury, vasospasm, dissection, stroke, contrast allergy, and nephropathy.…”

Section: Limitationsmentioning

confidence: 99%

Cerebral Digital Subtraction Angiography in Acute Intracranial Hemorrhage: Considerations in Critically Ill Children

Harrar

Sun

Goss³

et al. 2022

J Child Neurol

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Cerebrovascular disorders are an important cause of morbidity and mortality in children. Although minimally invasive, cerebral digital subtraction angiography (DSA) has been shown to be safe in children and is a valuable, and perhaps underutilized, technique for the diagnosis and management of pediatric cerebrovascular disorders in the critical care setting. Through a case-based approach, we explore the utility of DSA in critically ill children with acute intracranial hemorrhage (ICH). We discuss the use of DSA in the acute management of aneurysm and arteriovenous malformation rupture as well as cerebral vasospasm. Those caring for critically ill children with acute ICH should consider cerebral DSA as part of a comprehensive approach to the diagnosis and management of these conditions.

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Pediatric Acute Stroke Protocols in the United States and Canada

Cited by 21 publications

References 46 publications

Pediatric Stroke from Bench to Bedside: A Single-Center Experience in Saudi Arabia

Pediatric Stroke from Bench to Bedside: A Single-Center Experience in Saudi Arabia

Pediatric Stroke due to Thoracic Outlet Syndrome Treated with Thrombolysis and Thrombectomy: A Case Report

Cerebral Digital Subtraction Angiography in Acute Intracranial Hemorrhage: Considerations in Critically Ill Children

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