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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Diagnostic delays in paediatric stroke.

Andrew A Mallick1, Vijeya Ganesan2, Fenella J Kirkham3

  • 1Department of Paediatric Neurology, Bristol Royal Hospital for Children, Bristol, UK.

Journal of Neurology, Neurosurgery, and Psychiatry
|October 25, 2014
PubMed
Summary

Diagnosing childhood stroke is often delayed, particularly arterial ischemic stroke (AIS). Magnetic resonance imaging (MRI) should be the first choice for imaging suspected AIS to ensure timely diagnosis.

Keywords:
CEREBROVASCULAR DISEASEMRIPAEDIATRICPAEDIATRIC NEUROLOGYSTROKE

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Area of Science:

  • Pediatric Neurology
  • Neuroradiology
  • Emergency Medicine

Background:

  • Stroke is a significant cause of mortality and severe morbidity in children.
  • Conditions mimicking stroke in children require prompt diagnosis and treatment.
  • Investigating diagnostic timelines is crucial for improving pediatric stroke care.

Purpose of the Study:

  • To investigate the time to diagnosis in a cohort of children experiencing stroke.
  • To identify delays in the diagnostic pathway for pediatric stroke.
  • To compare diagnostic times between arterial ischemic stroke (AIS) and hemorrhagic stroke (HS).

Main Methods:

  • Population-based prospective cohort study of children with stroke in Southern England.
  • Review of case notes, hospital admission databases, and radiology records.
  • Recording of symptom onset, hospital presentation, neuroimaging times, and clinical features.

Main Results:

  • Median time from symptom onset to diagnostic neuroimaging was 24.3 hours for AIS and 2.9 hours for HS.
  • CT scans were diagnostic in 66% of AIS cases, while MRI was diagnostic in 100%.
  • Delayed neuroimaging in AIS occurred with initial CT scans and presentations outside working hours.

Conclusions:

  • Diagnosis of AIS in children is significantly delayed at multiple stages.
  • Initial CT scanning, often non-diagnostic for AIS, is a major contributor to diagnostic delays.
  • MRI is recommended as the initial imaging modality for suspected childhood AIS.