Stroke and cerebrovascular disease in childhood
Stroke and cerebrovascular disease in childhood
Stroke, stroke-like illness and cerebrovascular disease present to the pae diatrician in a variety of ways and timely emergency management remains a considerable challenge. In the absence of comprehensive evidence-based guidelines, this article covers the clinical diagnosis, appropriate investigation and management of some of the commoner stroke syndromes presenting in childhood. Anaemia, hypertension and hyperhomocysteinaemia are modifiable risk factors which should be excluded; iron or folate supplementation may be required. Early magnetic resonance imaging with fat-saturated TI images of the neck to exclude dissection, angiography and venography are often diagnostic. Previously unrecognized cardiac disease is rarely revealed by echocardiography. Randomized controlled trials in adults suggest that intravenous or subcutaneous heparin improve outcome in venous sinus (sinovenous) thrombosis. Anticoagulation may prevent early recurrent embolism after carotid or vertebral dissection. Revascularization often reduces the frequency of transient ischaemic attacks in moyamoya (terminal internal carotid occlusion or severe stenosis with collaterals). Thrombolysis is currently contraindicated outside a 3-h time window which precludes the use of tissue plasminogen activator in most children. The development of clinical networks will allow rapid dissemination of good practice in the management of childhood stroke as the evidence base accumulates
Anaemia, sickle cell, Cerebrovascular disorders, Child, Congenital heart disease, Dissection, Magnetic resonance angiography, Magnetic resonance imaging, Middle cerebral artery, Moyamoya, MRA, MRI, Sinovenous thrombosis, Stenosis, Stroke, Varicella zoster
350-359
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
October 2003
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Abstract
Stroke, stroke-like illness and cerebrovascular disease present to the pae diatrician in a variety of ways and timely emergency management remains a considerable challenge. In the absence of comprehensive evidence-based guidelines, this article covers the clinical diagnosis, appropriate investigation and management of some of the commoner stroke syndromes presenting in childhood. Anaemia, hypertension and hyperhomocysteinaemia are modifiable risk factors which should be excluded; iron or folate supplementation may be required. Early magnetic resonance imaging with fat-saturated TI images of the neck to exclude dissection, angiography and venography are often diagnostic. Previously unrecognized cardiac disease is rarely revealed by echocardiography. Randomized controlled trials in adults suggest that intravenous or subcutaneous heparin improve outcome in venous sinus (sinovenous) thrombosis. Anticoagulation may prevent early recurrent embolism after carotid or vertebral dissection. Revascularization often reduces the frequency of transient ischaemic attacks in moyamoya (terminal internal carotid occlusion or severe stenosis with collaterals). Thrombolysis is currently contraindicated outside a 3-h time window which precludes the use of tissue plasminogen activator in most children. The development of clinical networks will allow rapid dissemination of good practice in the management of childhood stroke as the evidence base accumulates
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Published date: October 2003
Keywords:
Anaemia, sickle cell, Cerebrovascular disorders, Child, Congenital heart disease, Dissection, Magnetic resonance angiography, Magnetic resonance imaging, Middle cerebral artery, Moyamoya, MRA, MRI, Sinovenous thrombosis, Stenosis, Stroke, Varicella zoster
Identifiers
Local EPrints ID: 429524
URI: http://eprints.soton.ac.uk/id/eprint/429524
ISSN: 0957-5839
PURE UUID: 4d5163e4-71cc-4d06-a361-df5b05053a3a
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Date deposited: 28 Mar 2019 17:30
Last modified: 18 Mar 2024 02:54
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