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Arterial ischemic stroke in neonates, infants, and children: An overview of underlying conditions, imaging methods, and treatment modalities

Arterial ischemic stroke in neonates, infants, and children: An overview of underlying conditions, imaging methods, and treatment modalities
Arterial ischemic stroke in neonates, infants, and children: An overview of underlying conditions, imaging methods, and treatment modalities

Conditions associated with arterial ischemic stroke (AIS) in children include congenital heart malformations, sickle cell disease, and meningitis, although around half of all cases are cryptogenic. Up to 80% of children with ischemic stroke have cerebrovascular disease, and case control studies demonstrate an association of arterial ischemic stroke in children with hereditary prothrombotic risk factors and infections such as Varicella. Conventional risk factors, such as hypertension and dyslipidemia, may also play a role and most children have several potential triggers rather than a single cause. Treatment recommendations are based on small case series or have been adapted from adult stroke studies; there are no evidence-based data on efficacy in children. Low-dose aspirin appears to be relatively safe. Anticoagulation with heparins, for example, low-molecular-weight heparin or warfarin, may be indicated in children with cardioembolic stroke, arterial dissection, or persistent hypercoagulable states, and blood transfusion has a role in patients with sickle cell disease. Tissue plasminogen activator has been used in a few patients within 3 hours of the onset of symptoms. At present, the benefit of treatment has to be weighed against the risk for each patient, but randomized controlled trials for primary prevention, acute treatment, and secondary prevention of pediatric ischemic stroke are urgently needed.

Arterial ischemic stroke, Children, Etiology, Magnetic resonance, Prothrombotic risk factors, Therapy
2567-689X
405-414
Nowak-Göttl, Ulrike
ccdfa168-34d8-4aeb-9f93-bd1fa432b4ff
Günther, Gudrun
c2bc5b8b-4637-49f1-8a56-fe589db009ba
Kurnik, Karin
f83ecae2-06f0-45f7-afbc-1250dd506525
Sträter, Ronald
0d8bd991-4d4f-46c2-bc64-1867b223779e
Kirkham, Fenella
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Nowak-Göttl, Ulrike
ccdfa168-34d8-4aeb-9f93-bd1fa432b4ff
Günther, Gudrun
c2bc5b8b-4637-49f1-8a56-fe589db009ba
Kurnik, Karin
f83ecae2-06f0-45f7-afbc-1250dd506525
Sträter, Ronald
0d8bd991-4d4f-46c2-bc64-1867b223779e
Kirkham, Fenella
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58

Nowak-Göttl, Ulrike, Günther, Gudrun, Kurnik, Karin, Sträter, Ronald and Kirkham, Fenella (2003) Arterial ischemic stroke in neonates, infants, and children: An overview of underlying conditions, imaging methods, and treatment modalities. Thrombosis and Hemostasis, 29 (4), 405-414. (doi:10.1055/s-2003-42590).

Record type: Review

Abstract

Conditions associated with arterial ischemic stroke (AIS) in children include congenital heart malformations, sickle cell disease, and meningitis, although around half of all cases are cryptogenic. Up to 80% of children with ischemic stroke have cerebrovascular disease, and case control studies demonstrate an association of arterial ischemic stroke in children with hereditary prothrombotic risk factors and infections such as Varicella. Conventional risk factors, such as hypertension and dyslipidemia, may also play a role and most children have several potential triggers rather than a single cause. Treatment recommendations are based on small case series or have been adapted from adult stroke studies; there are no evidence-based data on efficacy in children. Low-dose aspirin appears to be relatively safe. Anticoagulation with heparins, for example, low-molecular-weight heparin or warfarin, may be indicated in children with cardioembolic stroke, arterial dissection, or persistent hypercoagulable states, and blood transfusion has a role in patients with sickle cell disease. Tissue plasminogen activator has been used in a few patients within 3 hours of the onset of symptoms. At present, the benefit of treatment has to be weighed against the risk for each patient, but randomized controlled trials for primary prevention, acute treatment, and secondary prevention of pediatric ischemic stroke are urgently needed.

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More information

Published date: August 2003
Keywords: Arterial ischemic stroke, Children, Etiology, Magnetic resonance, Prothrombotic risk factors, Therapy

Identifiers

Local EPrints ID: 429520
URI: http://eprints.soton.ac.uk/id/eprint/429520
ISSN: 2567-689X
PURE UUID: f39648ec-2541-442d-93c2-fba8884dee83
ORCID for Fenella Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

Catalogue record

Date deposited: 28 Mar 2019 17:30
Last modified: 16 Mar 2024 03:22

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Contributors

Author: Ulrike Nowak-Göttl
Author: Gudrun Günther
Author: Karin Kurnik
Author: Ronald Sträter
Author: Fenella Kirkham ORCID iD

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