Treatment strategies for childhood stroke

Ischaemic stroke (arterial ischaemic stroke and cerebral sinovenous thrombosis) is increasingly recognised in childhood and has a significant attendant morbidity and mortality.

To review the most recent evidence underpinning treatment of childhood ischaemic stroke.

A literature search was performed through Medline and Cochrane Reviews database using search terms such as management/treatment/therapy of ischaemic stroke in children, anticoagulants, thrombolysis, aspirin for the prevention of stroke in childhood. Articles reviewed were published within the last 20 years.

Two separate treatment guidelines for childhood ischaemic stroke have been published and are those of the Royal College of Physicians in the UK and more recently the American Heart Association Stroke Council. In addition, the American College of Chest Physicians provide guidance on the use of anticoagulants and antithrombotic therapy in childhood stroke. Supportive care and neuroprotective strategies are important considerations in children with ischaemic stroke. Antithrombotic strategies are advocated; the choice of agent varies according to the underlying risk factors. Divergence between the published guidelines highlights the lack of a firm evidence base for published recommendations. Thrombolytic treatment is not advocated. Specific pathologies may require targeted management, for example surgical revascularisation for moyamoya. Clinical trials are urgently needed to establish comprehensive evidence-based guidelines for the treatment of childhood ischaemic stroke.