Paediatric stroke — a review of current guidelines for diagnosis and treatment
Abstract
Stroke, increasingly recognised in children in recent years, is an important cause of long-term morbidity and disability. It can be classified by the stroke type as either arterial ischaemic stroke (AIS), haemorrhagic stroke (HS), or cerebral sinovenous thrombosis (CSVT). Furthermore, perinatal and childhood stroke can be distinguished. A wide range of conditions associated with paediatric stroke has been identified, which differ significantly from those in adults. A paediatric stroke can also present with a variety of symptoms and signs, both specific and non-specific. Because of the diversity of the underlying risk factors, limited awareness among the medical community, and therefore insufficient recognition of paediatric stroke symptoms, diagnosis can be difficult and is often delayed. This limits access to acute interventions. The goal of this paper was to examine the current guidelines for the diagnosis and treatment of paediatric stroke.
Keywords: arterial ischaemic strokepaediatric strokemanagementguidelines
References
- Zahuranec DB, Brown DL, Lisabeth LD, et al. Is it time for a large, collaborative study of pediatric stroke? Stroke. 2005; 36(9): 1825–1829.
- Chung B, Wong V. Pediatric stroke among Hong Kong Chinese subjects. Pediatrics. 2004; 114(2): e206–e212.
- DeVeber G. In pursuit of evidence-based treatments for paediatric stroke: the UK and Chest guidelines. Lancet Neurol. 2005; 4(7): 432–436.
- Mallick AA, Ganesan V, Kirkham FJ, et al. Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study. Lancet Neurol. 2014; 13(1): 35–43.
- Fullerton HJ, Wu YW, Zhao S, et al. Risk of stroke in children: ethnic and gender disparities. Neurology. 2003; 61(2): 189–194.
- Hebert D, Lindsay MP, McIntyre A, et al. Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update 2015. Int J Stroke. 2016; 11(4): 459–484.
- deVeber G, Andrew M, Adams C, et al. Canadian Pediatric Ischemic Stroke Study Group. Cerebral sinovenous thrombosis in children. N Engl J Med. 2001; 345(6): 417–423.
- Laugesaar R, Kolk A, Uustalu U, et al. Epidemiology of childhood stroke in Estonia. Pediatr Neurol. 2010; 42(2): 93–100.
- Głodek-Brzozowska E, Czyżyk E. Zakrzepica zatok żylnych mózgowia u dzieci - charakterystyka czynników ryzyka, przebiegu klinicznego i leczenia. Neurologia Dziecięca. 2015; 24(49): 25–9.
- deVeber GA, Kirton A, Booth FA, et al. Epidemiology and Outcomes of Arterial Ischemic Stroke in Children: The Canadian Pediatric Ischemic Stroke Registry. Pediatr Neurol. 2017; 69: 58–70.
- Fullerton HJ, Chetkovich DM, Wu YW, et al. Deaths from stroke in US children, 1979 to 1998. Neurology. 2002; 59(1): 34–39.
- Wang Y, Rudd AG, Wolfe CDA. Age and ethnic disparities in incidence of stroke over time: the South London Stroke Register. Stroke. 2013; 44(12): 3298–3304.
- Roach ES, Golomb MR, Adams R, et al. American Heart Association Stroke Council, Council on Cardiovascular Disease in the Young. Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke. 2008; 39(9): 2644–2691.
- Committee AC. Guideline for the diagnosis and acute management of childhood stroke. ; 2017.
- Nelson KB, Lynch JK. Stroke in newborn infants. Lancet Neurol. 2004; 3(3): 150–158.
- Guz W, Kostkiewicz A, Stopa J. Radiological and clinical aspects and differences of childhood stroke. Przegląd Medyczny Uniwersytetu Rzeszowskiego i Narodowego Instytutu Leków w Warszawie. 2012; 2: 179–92.
- Tuckuviene R, Christensen AL, Helgestad J, et al. Paediatric arterial ischaemic stroke and cerebral sinovenous thrombosis in Denmark 1994-2006: a nationwide population-based study. Acta Paediatr. 2011; 100(4): 543–549.
- deVeber GA, MacGregor D, Curtis R, et al. Neurologic outcome in survivors of childhood arterial ischemic stroke and sinovenous thrombosis. J Child Neurol. 2000; 15(5): 316–324.
- Lasek-Bal A, Kopyta I, Warsz-Wianecka A, et al. Risk factor profile in patients with stroke at a young age. Neurol Res. 2018; 40(7): 593–599.
- Strzelecka J, Skadorwa T, Franckiewicz M, et al. A case of symmetric retrograde thromboembolic cerebral infarction in an 8-year-old child due to arterial thoracic outlet syndrome. Childs Nerv Syst. 2018; 34(12): 2503–2507.
- Kopyta I, Marszał E. Czynniki ryzyka udaru mózgu u dzieci II. Zaburzenia gospodarki lipidowej w etiopatogenezie udaru niedokrwiennego mózgu u dzieci. Udar Mózgu Problemy Interdyscypinarne. 2004; 6(2): 57–64.
- Pilarska E. Udar niedokrwienny u dzieci: czynniki ryzyla, objawy, leczenie, następstwa. Neurologia Dziecięca. 2009; 18(36): 13–8.
- Mackay MT, Wiznitzer M, Benedict SL, et al. International Pediatric Stroke Study Group. Arterial ischemic stroke risk factors: the International Pediatric Stroke Study. Ann Neurol. 2011; 69(1): 130–140.
- Mallick AA, Ganesan V, Kirkham FJ, et al. Diagnostic delays in paediatric stroke. J Neurol Neurosurg Psychiatry. 2015; 86(8): 917–921.
- deVeber GA. Delays in the timely diagnosis of stroke in children. Nat Rev Neurol. 2010; 6(2): 64–66.
- Yock-Corrales A, Mackay MT, Mosley I, et al. Acute childhood arterial ischemic and hemorrhagic stroke in the emergency department. Ann Emerg Med. 2011; 58(2): 156–163.
- Royal College of Paediatrics and Child Health. Stroke in childhood. Clinical guideline for diagnosis, management and rehabilitation. 2017 [Available from: https://www...uk/sites/default/files/2019-/Stroke%20guideline%2008. rcpch ac uk/sites/default/files/2019-04/Stroke%20guideline%2008 04. ; 19: pdf.
- Witek I, Kroczka S, Kaciński M. Charakterystyka udaru niedokrwiennego u dzieci w latach 1968-1998 i 2010-2015. Przegląd Lekarski. 2016; 73(3): 161–6.
- Zimmer JA, Garg BP, Williams LS, et al. Age-related variation in presenting signs of childhood arterial ischemic stroke. Pediatr Neurol. 2007; 37(3): 171–175.
- Kirton A, Armstrong-Wells J, Chang T, et al. International Pediatric Stroke Study Investigators. Symptomatic neonatal arterial ischemic stroke: the International Pediatric Stroke Study. Pediatrics. 2011; 128(6): e1402–e1410.
- Brouwer AJ, Groenendaal F, Koopman C, et al. Intracranial hemorrhage in full-term newborns: a hospital-based cohort study. Neuroradiology. 2010; 52(6): 567–576.
- Adil MM, Qureshi AI, Beslow LA, et al. Transient ischemic attack requiring hospitalization of children in the United States: kids' inpatient database 2003 to 2009. Stroke. 2014; 45(3): 887–888.
- Ichord RN, Bastian R, Abraham L, et al. Interrater reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a multicenter study. Stroke. 2011; 42(3): 613–617.
- Kitchen L, Westmacott R, Friefeld S, et al. The pediatric stroke outcome measure: a validation and reliability study. Stroke. 2012; 43(6): 1602–1608.
- Mackay MT, Chua ZK, Lee M, et al. Stroke and nonstroke brain attacks in children. Neurology. 2014; 82(16): 1434–1440.
- Martin C, von Elm E, El-Koussy M, et al. Swiss Neuropediatric Stroke Registry study group. Delayed diagnosis of acute ischemic stroke in children - a registry-based study in Switzerland. Swiss Med Wkly. 2011; 141: w13281.
- DeLaroche AM, Sivaswamy L, Farooqi A, et al. Pediatric Stroke and Its Mimics: Limitations of a Pediatric Stroke Clinical Pathway. Pediatr Neurol. 2018; 80: 35–41.
- Mackay MT, Yock-Corrales A, Churilov L, et al. Differentiating Childhood Stroke From Mimics in the Emergency Department. Stroke. 2016; 47(10): 2476–2481.
- Mirsky DM, Beslow LA, Amlie-Lefond C, et al. International Paediatric Stroke Study Neuroimaging Consortium and the Paediatric Stroke Neuroimaging Consortium. Pathways for Neuroimaging of Childhood Stroke. Pediatr Neurol. 2017; 69: 11–23.
- Yock-Corrales A, Barnett P. The role of imaging studies for evaluation of stroke in children. Pediatr Emerg Care. 2011; 27(10): 966–74; quiz 975.
- Mitomi M, Kimura K, Aoki J, et al. Comparison of CT and DWI findings in ischemic stroke patients within 3 hours of onset. J Stroke Cerebrovasc Dis. 2014; 23(1): 37–42.
- Nael K, Khan R, Choudhary G, et al. Six-minute magnetic resonance imaging protocol for evaluation of acute ischemic stroke: pushing the boundaries. Stroke. 2014; 45(7): 1985–1991.
- Rivkin MJ, Bernard TJ, Dowling MM, et al. Guidelines for Urgent Management of Stroke in Children. Pediatr Neurol. 2016; 56: 8–17.
- Ferriero DM, Fullerton HJ, Bernard TJ, et al. American Heart Association Stroke Council and Council on Cardiovascular and Stroke Nursing. Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke. 2019; 50(3): e51–e96.
- Amlie-Lefond C, Gill JC. Pharmacology in childhood arterial ischemic stroke. Semin Pediatr Neurol. 2010; 17(4): 237–244.
- Casaubon LK, Boulanger JM, Glasser Ev, et al. Heart and Stroke Foundation of Canada Canadian Stroke Best Practices Advisory Committee. Canadian Stroke Best Practice Recommendations: Acute Inpatient Stroke Care Guidelines, Update 2015. Int J Stroke. 2016; 11(2): 239–252.
- Rivkin MJ, deVeber G, Ichord RN, et al. Thrombolysis in pediatric stroke study. Stroke. 2015; 46(3): 880–885.
- Gerstl L, Olivieri M, Heinen F, et al. Successful mechanical thrombectomy in a three-year-old boy with cardioembolic occlusion of both the basilar artery and the left middle cerebral artery. Eur J Paediatr Neurol. 2016; 20(6): 962–965.
- Papanagiotou P, Ntaios G. Endovascular Thrombectomy in Acute Ischemic Stroke. Circ Cardiovasc Interv. 2018; 11(1): e005362.
- Wilson JL, Eriksson CO, Williams CN. Endovascular Therapy in Pediatric Stroke: Utilization, Patient Characteristics, and Outcomes. Pediatr Neurol. 2017; 69: 87–92.e2.
- Cobb MIP, Laarakker AS, Gonzalez LF, et al. Endovascular Therapies for Acute Ischemic Stroke in Children. Stroke. 2017; 48(7): 2026–2030.
- Shah S, Murthy SB, Whitehead WE, et al. Decompressive hemicraniectomy in pediatric patients with malignant middle cerebral artery infarction: case series and review of the literature. World Neurosurg. 2013; 80(1-2): 126–133.
- Perenc L. Ischemic strokes in children – review of the related literature. Prz Med Uniw Rzesz Inst Leków. 2013; 2: 236–51.
- Krishnamurthi RV, deVeber G, Feigin VL, et al. GBD 2013 Stroke Panel Experts Group. Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Children and Youth Aged 0-19 Years: Data from the Global and Regional Burden of Stroke 2013. Neuroepidemiology. 2015; 45(3): 177–189.
- Steinlin M, Roellin K, Schroth G. Long-term follow-up after stroke in childhood. Eur J Pediatr. 2004; 163(4-5): 245–250.
- Kopyta I, Sarecka-Hujar B, Skrzypek M, et al. Retracted: Post-stroke epilepsy in Polish paediatric patients. Dev Med Child Neurol. 2015; 57(8): 780–785.
- Sarecka-Hujar B, Kopyta I. Poststroke epilepsy: current perspectives on diagnosis and treatment. Neuropsychiatr Dis Treat. 2019; 15: 95–103.
- Fox CK, Glass HC, Sidney S, et al. Acute seizures predict epilepsy after childhood stroke. Ann Neurol. 2013; 74(2): 249–256.
- Lee YY, Lin KL, Wang HS, et al. Risk factors and outcomes of childhood ischemic stroke in Taiwan. Brain Dev. 2008; 30(1): 14–19.
- Hogan AM, Kirkham FJ, Isaacs EB. Intelligence after stroke in childhood: review of the literature and suggestions for future research. J Child Neurol. 2000; 15(5): 325–332.
- O'Keeffe F, Liégeois F, Eve M, et al. Neuropsychological and neurobehavioral outcome following childhood arterial ischemic stroke: attention deficits, emotional dysregulation, and executive dysfunction. Child Neuropsychol. 2014; 20(5): 557–582.
- Lo WD, Hajek C, Pappa C, et al. Outcomes in children with hemorrhagic stroke. JAMA Neurol. 2013; 70(1): 66–71.
- Goeggel Simonetti B, Cavelti A, Arnold M, et al. Long-term outcome after arterial ischemic stroke in children and young adults. Neurology. 2015; 84(19): 1941–1947.
- Fullerton HJ, Wintermark M, Hills NK, et al. VIPS Investigators. Risk of Recurrent Arterial Ischemic Stroke in Childhood: A Prospective International Study. Stroke. 2016; 47(1): 53–59.
- Stacey A, Toolis C, Ganesan V. Rates and Risk Factors for Arterial Ischemic Stroke Recurrence in Children. Stroke. 2018; 49(4): 842–847.