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Investigation and management of childhood stroke

Investigation and management of childhood stroke
Investigation and management of childhood stroke

It is now clear that a number of paediatric emergencies with a neurological presentation, including hemiparesis, visual loss, seizures and coma, commonly have a vascular basis which may not be obvious on CT scan. Although many children do well, as there is significant mortality as well as morbidity for childhood stroke, in addition to a high risk for recurrence, making a diagnosis in the acute phase important. Venography and arteriography (including the neck vessels if the intracranial vessels are normal) are usually indicated despite the problems i.e. contrast CT requires a high dose of radiation while emergency MR usually requires anaesthesia and conventional arteriography carries a small risk of stroke. Surgical decompression may be life-saving in ischaemic as well as haemorrhagic stroke. It is unusual for children with anterior circulation stroke to be triaged quickly enough (<4.5 h) for thrombolysis but this may occasionally be appropriate in posterior circulation occlusion associated with coma, where the time window is longer (<12 h). Anticoagulation carries relatively low risk and may be of benefit for children with venous sinus thrombosis (acutely and when at risk subsequently) or extracranial dissection. Aspirin to attempt to reduce the recurrence risk is appropriate in the medium term for the majority of patients with arterial ischaemic stroke. Iron and B vitamin deficiencies should be excluded or treated.

Anaemia, Cerebral venous sinus thrombosis, Cerebrovascular diseases, Magnetic resonance, Posterior reversible encephalopathy syndrome, Vasculopathy
1751-7222
428-438
Kirkham, Fenella
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Kirkham, Fenella
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58

Kirkham, Fenella (2010) Investigation and management of childhood stroke. Paediatrics and Child Health, 20 (9), 428-438. (doi:10.1016/j.paed.2010.08.005).

Record type: Review

Abstract

It is now clear that a number of paediatric emergencies with a neurological presentation, including hemiparesis, visual loss, seizures and coma, commonly have a vascular basis which may not be obvious on CT scan. Although many children do well, as there is significant mortality as well as morbidity for childhood stroke, in addition to a high risk for recurrence, making a diagnosis in the acute phase important. Venography and arteriography (including the neck vessels if the intracranial vessels are normal) are usually indicated despite the problems i.e. contrast CT requires a high dose of radiation while emergency MR usually requires anaesthesia and conventional arteriography carries a small risk of stroke. Surgical decompression may be life-saving in ischaemic as well as haemorrhagic stroke. It is unusual for children with anterior circulation stroke to be triaged quickly enough (<4.5 h) for thrombolysis but this may occasionally be appropriate in posterior circulation occlusion associated with coma, where the time window is longer (<12 h). Anticoagulation carries relatively low risk and may be of benefit for children with venous sinus thrombosis (acutely and when at risk subsequently) or extracranial dissection. Aspirin to attempt to reduce the recurrence risk is appropriate in the medium term for the majority of patients with arterial ischaemic stroke. Iron and B vitamin deficiencies should be excluded or treated.

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More information

Published date: September 2010
Keywords: Anaemia, Cerebral venous sinus thrombosis, Cerebrovascular diseases, Magnetic resonance, Posterior reversible encephalopathy syndrome, Vasculopathy

Identifiers

Local EPrints ID: 429212
URI: http://eprints.soton.ac.uk/id/eprint/429212
ISSN: 1751-7222
PURE UUID: ec26eebf-93fb-40d4-8403-10db2f262f85
ORCID for Fenella Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

Catalogue record

Date deposited: 22 Mar 2019 17:30
Last modified: 07 Oct 2020 01:46

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