[Strokes and their causes in children]
Insights
Pediatric stroke is classified into hemorrhagic and ischemic types, with diverse causes including vascular malformations and blood disorders. A diagnostic algorithm aids in identifying stroke types and causes in children.
Area of Science:
- Neurology
- Pediatrics
- Vascular Medicine
Context:
- Pediatric stroke presents unique etiological and clinical challenges.
- Understanding stroke subtypes is crucial for effective management in children.
- Previous literature and clinical observations form the basis of this study.
Purpose:
- To characterize the types and principle causes of stroke in children aged 5-15 years.
- To propose definitions for metabolic and non-differentiated strokes in pediatric populations.
- To present a reliable algorithm for the clinico-instrumental diagnostic screening of stroke in children during the acute period.
Summary:
- The study categorizes pediatric strokes into intracerebral/subarachnoidal hemorrhages (etiologies: arteriovenous malformations, blood disorders, coagulopathy) and ischemic strokes (thrombotic, embolic, hemodynamic).
- New definitions are suggested for metabolic stroke (mitochondrial encephalopathy, homocystinuria) and non-differentiated stroke (connective tissue disorders).
- A diagnostic algorithm is proposed to identify stroke causes and types in the acute phase.
Impact:
- Provides a comprehensive classification of pediatric stroke subtypes and their causes.
- Introduces novel definitions for specific stroke categories in children.
- Offers a practical diagnostic tool to improve the timely and accurate identification of stroke in pediatric patients.
Abstract:
Based on the literature and their own observations of 44 children aged 5-15 years (27 girls, 17 boys) with prior strokes, the authors characterize the types of strokes and principle causes of the disease as follows: (1) intracerebral and subarachnoidal hemorrhages (key etiology--arteriovenous malformations, blood disorders, coagulopathy, thrombocytopenias, thrombocytopathy, etc.) and (2) ischemic strokes i.e. (i) thrombotic (congenital and acquired vascular aplasias, angiitis, antiphospholipoid and viral vasculopathy, blood system coagulate activation, etc.); (ii) embolic (cardiogenic, septic, placental, etc.) and (iii) hemodynamic as a consequence of severe cardiomyopathy and disrupted total hemodynamics. The definitions of metabolic stroke as a complication of mitochondrial encephalopathy, homocystinuria and non-differentiated stroke caused more often by emergence of pathologic weariness of connective tissues were suggested. To elicit the stroke causes and types in children, the authors propose a reliable algorithm for clinico-instrumental diagnostic screening in acute period of stroke.
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