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Published on: April 21, 2017
Brain attacks and stroke in children
Mark T Mackay1,2,3,4, Paul Monagle2,4, Franz E Babl5,2,4
1Department of Neurology.
Insights
Emergency physicians face challenges diagnosing acute neurological disorders in children. Early recognition of childhood stroke is crucial for timely treatment and improved outcomes, differentiating it from mimics.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Neuroimaging
Background:
- Emergency physicians are the first responders for children with acute neurological disorders.
- Differentiating serious conditions like stroke from benign ones like migraine is difficult.
- Clinical assessment guides decisions on emergent neuroimaging.
Purpose of the Study:
- To review disorders causing acute focal neurological dysfunction in children.
- To emphasize early recognition of childhood stroke for thrombolytic therapy.
- To discuss diagnostic clues and differences from adult presentations.
Main Methods:
- Literature review of childhood stroke and neurological mimics.
- Analysis of clinical presentation differentiating stroke from mimics.
- Discussion of neuroimaging modalities for hemorrhagic and ischemic stroke.
Main Results:
- Childhood stroke requires early identification for potential thrombolytic treatment.
- Specific symptoms and signs help distinguish stroke from mimics in children.
- Hemorrhagic and ischemic strokes present differently, influencing imaging choices.
Conclusions:
- Improved care for childhood brain attacks necessitates coordinated approaches.
- System improvements, similar to adult stroke protocols, are needed.
- Accurate and timely diagnosis is key to optimizing outcomes.
Abstract:
Emergency physicians are often the first point of contact in children presenting with acute neurological disorders. Differentiating serious disorders, such as stroke, from benign disorders, such as migraine, can be challenging. Clinical assessment influences decision-making, in particular the need for emergent neuroimaging to confirm diagnosis. This review describes the spectrum of disorders causing 'brain attack' symptoms, or acute onset focal neurological dysfunction, with particular emphasis on childhood stroke, because early recognition is essential to improve access to thrombolytic treatments, which have improved outcomes in adults. Clues to diagnosis of specific conditions are discussed. Symptoms and signs, which discriminate stroke from mimics, are described, highlighting differences to adults. Haemorrhagic and ischaemic stroke have different presenting features, which influence choice of the most appropriate imaging modality to maximise diagnostic accuracy. Improvements in the care of children with brain attacks require coordinated approaches and system improvements similar to those developed in adults.
