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Stroke and nonstroke brain attacks in children

Mark T Mackay1, Zhi Kai Chua, Michelle Lee

  • 1From the Department of Neurology (M.T.M.) and Emergency Department (Z.K.C., M.L., F.E.B.), Royal Children's Hospital Melbourne, Parkville; Murdoch Childrens Research Institute (M.T.M., F.E.B.), Parkville; Florey Institute of Neurosciences and Mental Health (M.T.M., L.C., G.A.D.), Parkville; University of Melbourne (M.T.M., Z.K.C., M.L., L.C., P.M., G.A.D., F.E.B.), Parkville, Australia; and Hospital Nacional de Ninos (A.Y.-C.), San Jose, Costa Rica.

Neurology
|March 25, 2014
PubMed

Insights

Pediatric brain attacks present differently than in adults, with stroke being less common. Understanding these unique symptoms and causes is key to developing effective emergency department care pathways for children.

Area of Science:

  • Pediatric Neurology
  • Emergency Medicine
  • Clinical Pathway Development

Background:

  • Brain attacks in children, defined as abrupt-onset focal brain dysfunction, require specific diagnostic and management strategies.
  • Existing research often focuses on adult populations, necessitating a clearer understanding of pediatric presentations.

Purpose of the Study:

  • To characterize the symptoms, signs, and etiologies of brain attacks in children presenting to the emergency department.
  • To establish a foundation for creating a specialized pediatric brain attack clinical pathway.

Main Methods:

  • A prospective observational study was conducted on 287 children (1 month to 18 years) experiencing brain attacks.
  • Exclusion criteria included epilepsy, hydrocephalus, head trauma, and isolated headache.
  • Etiology was determined through clinical data, neuroimaging (CT, MRI), and other investigations, with comparisons to adult studies via meta-analysis.

Main Results:

  • Common symptoms included headache, vomiting, focal weakness, and seizures; common signs included focal weakness and ataxia.
  • Neuroimaging revealed abnormalities in 27% of CT scans and 62% of MRI scans.
  • The most frequent diagnoses were migraine (28%), seizures (15%), Bell palsy (10%), stroke (7%), and conversion disorders (6%), differing significantly from adult proportions.

Conclusions:

  • The etiological profile of pediatric brain attacks differs substantially from that observed in adults.
  • Stroke was the fourth most common diagnosis in children, highlighting a key difference from adult populations.
  • These findings are crucial for informing the development of evidence-based emergency department clinical pathways for pediatric brain attacks.
Abstract

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