Pediatric Stroke: Past, Present and Future

Friedman, Neil

doi:10.1016/j.yapd.2009.08.003

Cited by 24 publications

(14 citation statements)

References 156 publications

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“…Pediatric stroke (PS) is a relatively rare disease, having an estimated incidence of 2.5–13/100,000/year [1–4], but remains one of the most common causes of death in childhood, with a mortality rate of 0.6/100,000 dead/year [5, 6]. PS has also seriously high morbidity and long-term outcome and is nowadays gaining more interest because of its heavy consequences and costs, both personal and social.…”

Section: Introductionmentioning

confidence: 99%

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Pediatric Stroke: Clinical Findings and Radiological Approach

Lanni

Catalucci

Conti

et al. 2011

Stroke Research and Treatment

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This paper focuses on radiological approach in pediatric stroke including both ischemic stroke (Arterial Ischemic Stroke and Cerebral Sinovenous Thrombosis) and hemorrhagic stroke. Etiopathology and main clinical findings are examined as well. Magnetic Resonance Imaging could be considered as the first-choice diagnostic exam, offering a complete diagnostic set of information both in the discrimination between ischemic/hemorrhagic stroke and in the identification of underlying causes. In addition, Magnetic Resonance vascular techniques supply further information about cerebral arterial and venous circulation. Computed Tomography, for its limits and radiation exposure, should be used only when Magnetic Resonance is not available and on unstable patients.

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Section: Introductionmentioning

confidence: 99%

“…AIS, both in neonatal and childhood forms, has a higher incidence among males [5, 10–14] and black people [5, 7]. AIS is relapsing in 6%–37% of little patients [15–19] and the risk appears highest in the first 6 months after the first episode [19, 20].…”

Section: Introductionmentioning

confidence: 99%

Pediatric Stroke: Clinical Findings and Radiological Approach

Lanni

Catalucci

Conti

et al. 2011

Stroke Research and Treatment

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“…17 Our sample did not include any patients with germinal matrix hemorrhage and/or intraventricular hemorrhage associated with prematurity or patients with diffuse anoxic injury, consistent with prior categorizations of children affected by neurovascular insults 13 not associated with traumatic brain injury. 13,14,16 Of note, vascular insult was the single identifiable pathology in all patients in this study and family history was noncontributory in all cases.…”

Section: Study Populationmentioning

confidence: 70%

Surgical management of medically refractory epilepsy due to early childhood stroke

Ghatan

McGoldrick

Palmese

et al. 2014

PED

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Object The risk of developing epilepsy after perinatal stroke, hypoxic/ischemic injury, and intracerebral hemorrhage is significant, and seizures may become medically refractory in approximately 25% of these patients. Surgical management can be difficult due to multilobar or bilateral cortical injury, nonfocal or poorly lateralizing video electroencephalography (EEG) findings, and limited functional reserve. In this study the authors describe the surgical approaches, seizure outcomes, and complications in patients with epilepsy due to vascular etiologies in the perinatal period and early infancy. Methods The records were analyzed of 19 consecutive children and adults with medically refractory epilepsy and evidence of perinatal arterial branch occlusions, hypoxic/ischemic insult, or hemorrhagic strokes, who underwent surgery at the Comprehensive Epilepsy Center of Beth Israel Medical Center and St. Luke's-Roosevelt Hospital Center. Preoperative findings including MRI, video EEG, functional MRI, and neuropsychological testing were analyzed. The majority of patients underwent staged operations with invasive mapping, and all patients had either extra- or intraoperative functional mapping. Results In 7 patients with large porencephalic cysts due to major arterial branch occlusions, periinsular functional hemispherotomy was performed in 4 children, and in 3 patients, multilobar resections/disconnections were performed, with 1 patient undergoing additional resections 3 years after initial surgery due to recurrence of seizures. All of these patients have been seizure free (Engel Class IA) after a mean 4.5-year follow-up (range 15–77 months). Another 8 patients had intervascular border-zone ischemic infarcts and encephalomalacia, and in this cohort 2 hemispherotomies, 5 multilobar resections/disconnections, and 1 focal cortical resection were performed. Seven of these patients remain seizure free (Engel Class IA) after a mean 4.5-year follow-up (range 9–94 months), and 1 patient suffered a single seizure after 2.5 years of seizure freedom (Engel Class IB, 33-month follow-up). In the final 4 patients with vascular malformation-associated hemorrhagic or ischemic infarction in the perinatal period, a hemispherotomy was performed in 1 case, multilobar resections in 2 cases, and in 1 patient a partial temporal lobectomy was performed, followed 6 months later by a complete temporal and occipital lobectomy due to ongoing seizures. All of these patients have had seizure freedom (Engel Class IA) with a mean follow-up of 4.5 years (range 10–80 months). Complications included transient monoparesis or hemiparesis in 3 patients, transient mutism in 1 patient, infection in 1 patient, and a single case of permanent distal lower-extremity weakness. Transient mood disorders (depression and anxiety) were observed in 2 patients and required medical/therapeutic intervention. Conclusions Epilepsy surgery is effective in controlling medically intractable seizures after perinatal vascular insults. Seizure foci tend to be widespread and rarely limited to the area of injury identified through neuroimaging, with invasive monitoring directing multilobar resections in many cases. Long-term functional outcomes have been good in these patients, with significant improvements in independence, quality of life, cognitive development, and motor skills, despite transient postoperative monoparesis or hemiparesis and occasional mood disorders.

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“…Numerous studies have demonstrated that cell-based therapeutic treatments can yield limited restorative results for neurodegenerative diseases. 16 Several stem cells are currently considered to be promising sources of cell-based therapeutic strategies, 17 because adult stem cells possess the plasticity to differentiate into multiple lineages. 18,19 Among adult stem cells, considering its considerable mass within the body, MDSCs from skeletal muscle may constitute a convenient source of stem cells for treating neurodegenerative diseases.…”

Section: Discussionmentioning

confidence: 99%

Neural differentiation of rat muscle-derived stem cells in the presence of valproic acid: A preliminary study

Kwon

Kim

et al. 2012

Tissue Eng Regen Med

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In this study, we chose valproic acid (VA) for inducing neural differentiation in rat muscle-derived stem cells (rMDSCs). After pre-induction with basic fibroblast growth factor (bFGF) and subsequent treatment with VA, VA-related cytotoxicity to rMDSCs was relatively low. In addition, VA-treated rMDSCs exhibited a neural-like morphology after 1, 4, and 7 days. The immunocytochemical results of VA-treated rMDSCs showed abundant cells stained positive for neuron-specific enolase (NSE) and neuron filament (NF) as neural markers, oligodendrocyte transcription factor 2 (Olig-2) as an oligodendrocyte marker, and glial fibrillary acidic protein (GFAP) as an astrocyte marker. Our results suggest that rMDSCs can be differentiated into a neural-like phenotype by using VA.

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Pediatric Stroke: Past, Present and Future

Cited by 24 publications

References 156 publications

Pediatric Stroke: Clinical Findings and Radiological Approach

Pediatric Stroke: Clinical Findings and Radiological Approach

Surgical management of medically refractory epilepsy due to early childhood stroke

Neural differentiation of rat muscle-derived stem cells in the presence of valproic acid: A preliminary study

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