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Childhood stoke is increasingly recognized , but studies remain
largly descriptive . Important differences from adult stroke include
the following: (1) frequently delayed or missed diagnosis,(2)
heterogenous and overlapping risk factors , and (3) developmental
differences in the cerebrovascular , neurologic , and coagulation
systems . These aspects limit the extrapolation of the results of
adult stroke research and present challenges in caring for children
with stroke . The incidence of childhood ischemic stroke exceeds 3.3
in 100,000 children per year , more than double the estimates from
past decades . The increased incidence reflects, in part ,
increased survival in previously fatal conditions predisposing to
stroke , including congenital heart disease , stickle cell anemia ,
and leukemia . Risk factors for stroke are recognized in more than
75% of children . Common risk factors include congenital heart
disease and sickle cell disease . Progressive arteriopathies ,
including vasculitis and moyamoya syndrome , are rate in children
with stroke ; however , transient arteriopathies including post-varicella
angiopathy are increasingly recognized . Prothrombotic abnormalities
are frequently present but of unclear significance. Adverse outcomes
after childhood stroke , including death in 10% , recurrence in 20%
, and neurologic deficits in two thirds of survivors could be
reduced with available stroke treatments . Aggressive prehospital
emergency care and transfer could improve access to hupeacute stroke
therapies including tPA . Currently , the diagnosis is delayed by
more than 24 hours from onset in most children . As in adults , tPA
will likely produce unacceptable rates of intracerebral hemmorrhage
unless given within 3 hours of stroke symptom onset. The appropriate
choices for in hospital treatment and secondary preventative
strategies , including aspitin and anticoagulants , are
controversial.Empiric recommendations are published; however ,
age-appropriate clinical trials are urgently needed .The large
multiational networks of investigators necessary for designing and
conducting these future trials are now being formed.
Journal of Child Neurology |
