Pediatric stroke: current diagnostic and management challenges

Rajani, Nikil K; Pearce, Kirsten; Campion, Tom; Salpietro, Vincenzo; Planells, Mariana; Chong, Winston; Patankar, Tufail; Mankad, Kshitij

doi:10.21037/qims.2018.11.09

Cited by 14 publications

(15 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The World Health Organization stroke guidelines recommend the use of thrombolytic agents or clot-dissolving drugs, such as alteplase, for restoring blood flow when given rapidly enough to help reduce brain damage, in the pediatric population [ 5 ]. Alteplase acts by binding to fibrin at lysine-binding sites resulting in the conversion of plasminogen to plasmin [ 6 ]. The effectiveness of alteplase is shown in multiple trials and is approved by the FDA for patients over the age of 18 [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Management of Pediatric Strokes With Alteplase (Tissue Plasminogen Activator)

Filatov¹,

Alvarez²,

Seibert³

et al. 2021

Cureus

View full text Add to dashboard Cite

In the pediatric population, ischemic stroke is rare. Pediatric patients with acute ischemic stroke are eligible for intravenous thrombolysis and/or mechanical thrombectomy. However, due to the rare occurrence of strokes and national shortage of pediatric neurologists, timely diagnosis and appropriate treatment can be challenging. We report a case of a 16-year-old female who presented with an acute ischemic stroke to our adult comprehensive stroke program.

show abstract

Section: Discussionmentioning

confidence: 99%

Management of Pediatric Strokes With Alteplase (Tissue Plasminogen Activator)

Filatov¹,

Alvarez²,

Seibert³

et al. 2021

Cureus

View full text Add to dashboard Cite

show abstract

“…On the other hand, ischemic strokes present a greater variety of symptoms, which could easily be confused with other less severe etiologies or their underlying pathology, widening the gap between symptom onset and diagnostic implementation. 7 As in hemorrhagic stroke, ischemic stroke also depends highly on time as a predictor of mortality, having an association between greater symptomsto-diagnosis time and a greater mortality. It was found that the first 10 hours from the onset of symptoms to the implementation of the diagnosis are critical for the survival of an ischemic stroke patient.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Clinical suspicion on the part of the general population and the first-contact physician is essential to initiate the multiple approaches necessary for the correct and timely diagnosis and treatment of pediatric stroke. 7 The prevalence of pediatric stroke varies enormously between different geographical areas, where the highest prevalence can be found in developed countries, while a lower prevalence can be found in developing countries, as reported by Krishnamurthi et al 8 This can be explained due to a greater availability of technology for the detection of pediatric stroke as well as a greater clinical suspicion. Furthermore, the countries with the highest prevalences show lower mortality rates, 8 highlighting the importance of early detection of pediatric stroke.…”

Section: Introductionmentioning

confidence: 97%

Characteristics of Pediatric Stroke and Association of Delayed Diagnosis with Mortality in a Mexican Tertiary Care Hospital

Garza-Alatorre

Falcon-Delgado

et al. 2021

Neuropediatrics

View full text Add to dashboard Cite

Background and objectives Pediatric cerebrovascular disease carries significant morbidity and mortality. Early recognition of a pediatric stroke as well and its most common risk factors are important, but that diagnosis is often delayed. It is believed that the incidence in our center is higher than it appears. This study aims to assess the incidence and characteristics of the pediatric stroke in our university hospital. Likewise, this study seeks to evaluate if a longer symptoms-to-diagnosis time is associated with mortality in patients with ischemic stroke. Methods A retrospective study including children with stroke admitted to the UANL University Hospital from January 2013 to December 2016. Results A total of 41 patients and 46 stroke episodes were admitted. About 45.7% had an ischemic stroke and 54.3% had a hemorrhagic stroke. A mortality of 24.4% and a morbidity of 60.9% were recorded. Regarding ischemic and hemorrhagic stroke, an increased symptoms-to-diagnosis time and a higher mortality were obtained with a relative risk of 2.667 (95% confidence interval [CI]: 1.09–6.524, p = 0.013) and 8.0 (95% CI: 2.18–29.24, p = < 0.0001), respectively. A continuous increase in the incidence rate, ranging from 4.57 to 13.21 per 1,000 admissions comparing the first period (2013) versus the last period (2016), p = 0.02, was found in our center. Conclusions Pediatric stroke is a rare disease; however, its incidence shows a continuous increase. More awareness toward pediatric stroke is needed.

show abstract

“…According to current guidelines, due to potential side effects, systemic corticosteroids are only applied in emergencies or refractory situations, for example, respiratory distress in airway hemangioma (see below) [29]. Counseling of caregivers and medical staff of patients with PHACE syndrome with regard to typical symptoms of AIS (new hemiparesis and new seizures) [28] and unspecific symptoms of AIS (irritability and lethargy) [30] may be beneficial. Prothrombotic laboratory workup was positive in only a single patient from 2 published case series of patients with PHACE syndrome and AIS [28, 31], making concomitant coagulopathies in PHACE syndrome unlikely.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Epidemiology, Clinical Features, and Use of Early Supportive Measures in PHACE Syndrome: A European Multinational Observational Study

Disse¹,

Toelle

Schroeder

et al. 2020

Neuroepidemiology

View full text Add to dashboard Cite

Background: PHACE syndrome is a rare inborn condition characterized by large facial hemangiomas and variable malformations of the arterial system, heart, central nervous system, and eyes. According to Orphanet estimates, the prevalence is <1.0 per million. Data from Europe are limited to small case series, and there are no population-based data available. Objectives: We conducted the present study to provide population-based estimates of the disease prevalence of PHACE syndrome in children in Germany, Switzerland, and Austria. We compared these first systematic data on PHACE syndrome from Europe to published data from the PHACE Syndrome International Clinical Registry and Genetic Repository (USA). Clinical features in our cohort with PHACE syndrome were assessed in detail, including the need for early supportive measures. Methods: We used a population-based approach by means of a previously well-established network of child neurologists from Germany, Switzerland, and Austria (“ESNEK”) to identify potential patients. The patients’ guardians and child neurologists were asked to fill in questionnaires developed in collaboration with the International PHACE Registry. Results: We identified 19 patients with PHACE syndrome. Estimated prevalence rates were 6.5 per million in Switzerland, 0.59 per million in Germany, and 0.65 per million in Austria. A subset of 10 patients from Germany and Switzerland participated in our study, providing detailed clinical assessment (median age: 2.5 years; 9 females, 1 male). Cerebrovascular involvement was frequent (80%). Facial hemangioma extent correlated significantly with the number of organs involved (p = 0.011). In 9 out of 10 patients, facial hemangiomas were treated successfully with oral propranolol. Baseline demographic data as well as the rate of cerebrovascular and cardiovascular anomalies were in line with those from the US International PHACE Registry and other published PHACE cohorts. Conclusions: Our study provides population-based estimates for PHACE syndrome in 3 German-speaking countries. The data from Switzerland indicate that PHACE syndrome may be more prevalent than demonstrated by previous reports. Underreporting of PHACE syndrome in Germany and Austria likely accounts for the differences in prevalence rates. The clinical observation of a potential association between the size of facial hemangioma and extent of organ involvement warrants further investigation.

show abstract

Pediatric stroke: current diagnostic and management challenges

Cited by 14 publications

References 24 publications

Management of Pediatric Strokes With Alteplase (Tissue Plasminogen Activator)

Management of Pediatric Strokes With Alteplase (Tissue Plasminogen Activator)

Characteristics of Pediatric Stroke and Association of Delayed Diagnosis with Mortality in a Mexican Tertiary Care Hospital

Epidemiology, Clinical Features, and Use of Early Supportive Measures in PHACE Syndrome: A European Multinational Observational Study

Contact Info

Product

Resources

About