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Bilateral ischemic lesion of the ponto-mesencephalic junction, enhanced on the left side (day 1), 3d FLAIR, sagittal section. b Bilateral ischemic lesion of the ponto-mesencephalic junction, enhanced on the left side (day 1), axial section
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Stroke is a rare disease in childhood with an estimated incidence of 1-6/100.000. It has an increasingly recognised impact on child mortality along with its outcomes and effects on quality of life of patients and their families. Clinical presentation and risk factors of paediatric stroke are different to those of adults therefore it can be consider...
Citations
... In children, arterial ischemic stroke is the most common subtype, accounting for just over half of all cerebrovascular accidents [12]. Some authors mention in their papers [13] that IS in children can present with subtle symptoms, especially among newborns and small children. According to researchers, the clinical manifestations and risk factors of IS in children are different from those of adults; therefore, the disease can be considered an independent nosological entity [13,14]. ...
... Some authors mention in their papers [13] that IS in children can present with subtle symptoms, especially among newborns and small children. According to researchers, the clinical manifestations and risk factors of IS in children are different from those of adults; therefore, the disease can be considered an independent nosological entity [13,14]. To address the issue of uncertain clinical symptoms of IS in children and newborns, a significant aspect of the study involved evaluating the clinical signs of IS in that population. ...
Citation: Wessel, N.; Sprincean, M.; Sidorenko, L.; Revenco, N.; Hadjiu, S. Pediatric Ischemic Stroke: Clinical and Paraclinical Manifestations-Algorithms for Diagnosis and Treatment. Algorithms 2024, 17, 171. Abstract: Childhood stroke can lead to lifelong disability. Developing algorithms for timely recognition of clinical and paraclinical signs is crucial to ensure prompt stroke diagnosis and minimize decision-making time. This study aimed to characterize clinical and paraclinical symptoms of childhood and neonatal stroke as relevant diagnostic criteria encountered in clinical practice, in order to develop algorithms for prompt stroke diagnosis. The analysis included data from 402 pediatric case histories from 2010 to 2016 and 108 prospective stroke cases from 2017 to 2020. Stroke cases were predominantly diagnosed in newborns, with 362 (71%, 95% CI 68.99-73.01) cases occurring within the first 28 days of birth, and 148 (29%, 95% CI 26.99-31.01) cases occurring after 28 days. The findings of the study enable the development of algorithms for timely stroke recognition, facilitating the selection of optimal treatment options for newborns and children of various age groups. Logistic regression serves as the basis for deriving these algorithms, aiming to initiate early treatment and reduce lifelong morbidity and mortality in children. The study outcomes include the formulation of algorithms for timely recognition of newborn stroke, with plans to adopt these algorithms and train a fuzzy classifier-based diagnostic model using machine learning techniques for efficient stroke recognition.
... It can happen at any stage of life, but how it manifests itself varies with age, artery involvement, and underlying risk factors. Particularly those under the age of one-year, younger children typically appear with non-specific symptoms like seizures and disturbed mental state, whereas older children typically show with focal neurologic abnormalities like hemiplegia (1) . ...
... Однако повышение их титра, что важно учитывать на практике, может быть детерминировано разнообразными, в том числе приобретенными модифицируемыми факторами сосудистого повреждения. Вместе с тем выявление у пациента с сосудистой патологией коагулопатии или повышения вышеуказанных маркеров требует консультации гематолога и, соответственно, немедикаментозной и лекарственной коррекции [52]. ...
... У детей инсульту, как правило, предшествуют транзиторные ишемические атаки, проявляющиеся в виде острого моно-или гемипареза, нарушения речи и зрения, эпиприпадков. БМ может проявляться не только судорожным синдромом, но и хроническими головными болями и головокружением, синкопальными состояниями, гиперкинезами и постепенным снижением когнитивных функций [12,29,30,39,40,45,52]. По совокупным данным этих авторов, средняя частота встречаемости симптомов в клинике БМ следующая: слабость в ноге/руке правой или левой -в 40% случаев, онемение в одной, двух или во всех конечностях -в 25%, головная боль пульсирующего (давящего) характера и приступы судорог с потерей сознания или без него -в 20%, преходящее нарушение речи (отсутствие или затруднение речи в течение суток), кратковременное снижение зрения, когнитивные нарушения (забывчивость, ухудшение памяти) -в 15% случаев. ...
Ischemic stroke in young patients is an actual problem of modern angioneurology. You should know that in addition to the common causes of stroke (blood vessels, heart and circulatory system pathology, diabetes mellitus), one of the important ones is moyamoya disease. It has become more frequently registered among patients, including those of non-Asian origin in recent times. The disease often manifests itself as a stroke or transient ischemic attacks, and may initially be accompanied by various neurological manifestations for a long time. Late diagnosis of moyamoya disease due to the lack of knowledge of outpatient practitioners about this pathology may result in a stroke for the patient. It is a multifactorial disease with a genetic predisposition and is manifested by vascular remodeling in the system of internal and external carotid arteries (luminal occlusion) with the development of a collateral network resembling “cigarette smoke” during angiography. This defi nition is a literal translation of “moyamoya” from Japanese. The article gives a comprehensive, all-around view of the disease, the tactics of its detection and treatment, with an emphasis on modern methods of surgical revascularization. A clinical case from practice is of interest to internist clinicians as it is connected with atypical manifestation of the disease in an 18-year-old patient. The doctors focused on arterial hypertension as the main cause of the patient’s complaints, and moved away from the algorithm for detecting cerebral vascular pathology.
... Post-stroke, the focus shifts to determining the underlying etiology and modification of risk factors such as hypertension, diabetes mellitus, and hyperlipidemia, if possible [3]. Treatment with aspirin, clopidogrel, or dual antiplatelet therapy remains controversial in pediatric patients [16]. Following pediatric AIS, the development of seizures is a concern. ...
Acute ischemic stroke (AIS) is a significant source of morbidity and mortality and is one of the top causes of death in the United States. Of these patients, most are elderly individuals, compared to a limited proportion of cases seen in pediatrics. AIS is classically associated with age-dependent atherosclerotic disease processes secondary to comorbidities such as diabetes and hypertension. When considering the pediatric population, stroke is far less common and often requires workup of other underlying etiologies that create a hypercoagulable state. Here we present a case of an eight-year-old male with a left middle cerebral artery (MCA) ischemic stroke in the setting of increased factor VIII activity and SARS-CoV-2 antibodies.
... As intervenções fisioterapêuticas exigem a compreensão entre o que ocorre nos déficits estruturais e funcionais do organismo, bem como os fatores psicossociais, os quais podem atuar tanto como facilitadores, quanto como barreiras em diferentes condições de saúde (STUCKI, 2005 (SOUZA et al., 2010;GONÇALVES et al., 2018;ROSA et al., 2015;DOS SANTOS et al., 2014). ...
O Acidente Vascular Cerebral (AVC), quando ocorre na infância, pode causar grandes comorbidades, como sequelas motoras, cognitivas e comportamentais. Para a reabilitação pós AVC infantil a Fisioterapia dispõe de várias técnicas, recursos e métodos. Nesse sentido, este estudo teve como objetivo agrupar e apresentar intervenções fisioterapêuticas na área de Reabilitação Neurofuncional em Pediatria aplicadas em pacientes que sofreram acidente vascular cerebral, hemorrágico ou isquêmico. Para tanto, desenvolveu-se uma revisão sistemática e narrativa da literatura. Foi realizado um levantamento bibliográfico de artigos indexados nas principais bases de dados como PubMed, SciELO e LILACS-BIREME que reportam tratamento fisioterapêutico pós acidente vascular cerebral em crianças. Na sequência foi feito um levantamento de artigos científicos com abordagens de intervenções fisioterapêuticas, convencionalmente utilizadas em pacientes adultos, e que podem ser adaptadas e aplicadas na Reabilitação Neurofuncional em crianças, na faixa etária de interesse. Assim, as intervenções fisioterapêuticas no caso de AVC, isquêmico ou hemorrágico, em crianças devem ser realizadas na fase inicial, com a finalidade de evitar a morte de tecido cerebral, bem como maiores consequências desfavoráveis para o paciente. A Fisioterapia contribui no tratamento do AVC infantil por meio de alguns procedimentos, dentre eles, pode ser destacado a Terapia de Restrição e Indução do Movimento (TRIM), o Método Bobath, a Terapia do Espelho (TE), a Facilitação Neuromuscular Proprioceptiva (FNP), Fisioterapia Aquática e Cinesioterapia. Dessa forma, os tratamentos propostos pela Fisioterapia Neurológica estão centrados na manutenção da flexibilidade, promoção de força, facilitação das habilidades funcionais, bem como sentar ou andar, e fomentar padrões normais de movimento, induzir o desenvolvimento motor e promover a independência na mobilidade e na autonomia.
... Eles podem se manifestar de diferentes formas a depender da localização da artéria acometida, os fatores de risco subjacentes e a idade do paciente. O AVC em crianças mais jovens costuma gerar sintomas inespecíficos, como convulsões e estado mental alterado, principalmente naquelas menores de um ano de idade, enquanto crianças mais velhas costumam apresentar os déficits neurológicos focais, como a hemiplegia9,10 . ...
... Ischemic stroke (IS) is an acute violation of cerebral circulation. IS in the pediatric population is rare -1-6 cases per 100,000 children [1]. Population studies of ischemic stroke in children (aged 29 days to 18 years) show an annual incidence of 2.4 cases per 100,000 people, with a mortality rate of 4%. ...
... The risk factors for stroke differ depending on the age of the child and even on location (developed or developing country) also. [1] The investigations and treatment strategies are different, depending on the risk factors in a given child. Few of the risk factors like iron deficiency anemia, mineralizing angiopathy are more common in developing countries like India. ...
... [3] With early and appropriate intervention, few of the long-term sequelae can be prevented (for example, use of antithrombotic treatment to prevent recurrences) or at least their effect on the child minimized (for example, early rigorous physiotherapy for hemiparesis and functional deficit). [1] Due to lack of awareness about pediatric strokes among pediatricians, lack of access to advanced neuroimaging facilities and interventions, the clinical profile and outcome of stroke is likely to be different in developing countries like ours. Unfortunately, we do not have many publications (hospital based or community based) on pediatric strokes from India. ...
... Arterial dissection, especially if extracranial, needs anticoagulation for at least 6 months. [1] As is evident in the present study, the presence of seizures, cortical localization of infarct, and recurrences were associated with poor long-term cognitive outcomes. Early, daily intensive physiotherapy in the form of constraintinduced movement therapy, speech therapy, and occupational therapy can help to minimize the functional deficit associated with pediatric strokes. ...
... Knowledge of intracranial vascular territories and the predilections for certain pathologies may aid in narrowing the differential diagnosis. For example, posterior circulation infarctions are unusual in children and should raise suspicion for traumatic injury to the vertebrobasilar circulation, vasospasm secondary to migraine, or MELAS, particularly if the infarct is not in a strict vascular distribution (72)(73)(74)(75)(76). Thalamic strokes in older children typically occur in the setting of meningitis (infectious vasculitis), congenital heart disease, migraine, or trauma, while basal ganglia infarctions are often associated with infectious or parainfectious vasculopathy (i.e., FCA-i) (17,77). ...
ABSTRACT Although less common than in adults, stroke is the sixth leading cause of death in children, affecting ~2–13 children per 100,000 under 18 years of age. Because it is underappreciated clinically, the diagnosis of pediatric stroke is often delayed or even missed, or misdiagnosed as more common conditions such as migraine, epilepsy, or viral illnesses. Since pediatric stroke is caused by unique etiologies and can present differently than in adults, diagnostic imaging should be tailored to the specific and diverse causative entities and distinctive needs of the pediatric population. This chapter provides a comprehensive review of pediatric stroke, including the etiologies, diagnosis, and management, emphasizing the role of neuroimaging in diagnostic and treatment pathways. Understanding the distinct clinical entity of pediatric stroke and the role of imaging in diagnosis is important for early detection and treatment of this underappreciated disease.
... 5,6 Hyperacute recanalization therapies (thrombolysis/ thrombectomy) have proven efficacy in adult AIS. Current paediatric guidelines provide recommendations regarding paediatric use; however, the pathological substrate of AIS is significantly different in the two groups 7,8 and both approaches likely carry significant risk in children. A trial exploring the safety and efficacy of hyperacute thrombolysis in childhood AIS (Thrombolysis in Paediatric Stroke) 7 closed because of lack of recruitment and it is unlikely that any further trials of recanalization therapies will be conducted. ...
... Delays in diagnosis have been identified previously, with children often not being referred to tertiary care centres or facilities with MRI and specialized skills until >24 hours after deficit onset. 8,28 This highlights the need for increased education and awareness about childhood stroke amongst physicians and the public. ...
Aim
To identify clinical and radiological predictors of long‐term motor outcome after childhood‐onset arterial ischemic stroke (AIS) in the middle cerebral artery (MCA) territory.
Method
Medical records of 69 children (36 females, 33 males; median age at index AIS 3y 3mo, range: 1mo–16y) who presented to Great Ormond Street Hospital with first AIS in the MCA territory were reviewed retrospectively. Cases were categorized using the Childhood AIS Standardized Classification and Diagnostic Evaluation (CASCADE). Magnetic resonance imaging (MRI) and angiography were evaluated. An Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was calculated on MRI. The Recurrence and Recovery Questionnaire assessed motor outcome and was dichotomized into good/poor.
Results
Eventual motor outcome was good in 49 children and poor in 20. There were no acute radiological predictors of eventual motor outcome. At follow‐up, CASCADE 3A (i.e. moyamoya) and Wallerian degeneration were significantly associated with poor motor outcome. In the multivariate analysis, younger age and CASCADE 3A predicted poor motor outcome.
Interpretation
In the context of recommendations regarding unproven and potentially high‐risk hyperacute therapies for childhood AIS, prediction of outcome could usefully contribute to risk/benefit analysis. Unfortunately, paradigms used in adults, such as ASPECTS, are not useful in children in the acute/early subacute phase of AIS.
What this paper adds
Adult paradigms, such as the Alberta Stroke Program Early Computed Tomography Score system, are not useful for predicting outcome in children.
Younger children tend to have a poorer long‐term prognosis than older children.
Moyamoya is associated with poor prognosis.
