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Ischemic stroke in paediatrics - narrative review of the literature and two cases
Jozef Klucka1, Petr Stourac1, Roman Stoudek1
1Department of Paediatric Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University and University Hospital Brno, Jihlavska 20, 625 00 Brno, Czech Republic.
Insights
Pediatric stroke is rare and difficult to diagnose due to unique symptoms and risk factors in children. Early recognition and advanced neuroimaging are crucial for timely management of childhood stroke.
Area of Science:
- Neurology
- Pediatrics
- Emergency Medicine
Background:
- Childhood stroke is a rare neurological emergency with incidence rates of 1.3-13 per 100,000 patients.
- Clinical presentation and risk factors in pediatric stroke differ significantly from adult stroke.
- The rarity, age-specific variations, and diverse symptoms complicate early diagnosis and management.
Observation:
- Clinical history and examination are vital for identifying potential predisposing factors.
- Diffusion-weighted magnetic resonance imaging (DWI MR) is the gold standard for diagnosing pediatric stroke.
- Further investigations are guided by the patient's clinical status.
Findings:
- This review synthesizes current international guidelines and practical approaches for recognizing and managing pediatric stroke in emergency settings.
- Treatment strategies are often extrapolated from adult stroke protocols, highlighting a gap in pediatric-specific research.
- Two case reports illustrate the clinical progression of stroke in pediatric patients.
Implications:
- Improved diagnostic protocols and timely neuroimaging are essential for better outcomes in childhood stroke.
- Further research is needed to establish evidence-based acute treatment, secondary prevention, and rehabilitation strategies tailored for pediatric populations.
- Enhanced awareness and standardized management protocols can reduce diagnostic delays and improve care for children experiencing stroke.
Abstract:
Stroke is a rare condition in childhood with an estimated incidence of between 1.3-13/100.000 patients. Clinical manifestation and risk factors for paediatric stroke are different from those of adults. The uncommon incidence, age-associated difference and plethora of clinical symptoms make the diagnosis of such strokes extremely difficult and often delayed. The history and clinical examination should point to diseases or predisposing factors. Neuroimaging (DWI MR) is the golden standard for diagnosis of paediatric stroke and other investigations can be considered according to the clinical condition. Despite advances in paediatric stroke research and clinical care, questions remain unanswered regarding acute treatment, secondary prevention and rehabilitation. The treatment recommendations are mainly extrapolated from studies on adult populations. In the review authors summarized the clinical characteristics and diagnostic steps for stroke in children/adolescents based on the most recent international guidelines and practical directions for recognising and managing the child/adolescent with stroke in paediatric emergency. In the two case reports, we describe the clinical course in both stroke patients.
