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Acute ischemic stroke in childhood: a comprehensive review
Mario Mastrangelo1, Laura Giordo1, Giacomina Ricciardi1
1Child Neurology and Infantile Psychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.
Insights
Pediatric acute ischemic stroke is rare but challenging to manage. Implementing institutional protocols for rapid diagnosis and treatment improves outcomes and reduces delays in reperfusion therapies.
Area of Science:
- Neurology
- Pediatrics
- Emergency Medicine
Background:
- Acute ischemic stroke in children is a rare but serious medical emergency.
- Incidence rates vary, with higher occurrences in newborns (1/3500 live births) compared to older children (1-2/100,000 per year).
- Management is complex due to diverse age-dependent risk factors, subtle presentations, and limited evidence for acute therapies.
Purpose of the Study:
- To review and update the diagnosis and management strategies for pediatric acute ischemic stroke.
- To emphasize the importance of institutional protocols in optimizing stroke care for children.
- To highlight recent findings on treatment safety and the impact of rapid diagnostic pathways.
Main Methods:
- Review of current literature on pediatric acute ischemic stroke.
- Analysis of diagnostic work-up and treatment management approaches.
- Evaluation of institutional protocols for emergency stroke management.
Main Results:
- Thrombolysis in children shows a low risk of intracranial hemorrhage (2.1%).
- Implementation of institutional protocols is linked to faster neuroimaging and hyper-acute therapy access.
- Standard operating procedures aid in selecting candidates for neuroimaging among children with acute neurological symptoms.
Conclusions:
- Standardized institutional protocols are crucial for optimizing the diagnosis and management of pediatric ischemic stroke.
- Faster access to neuroimaging and reperfusion therapies improves long-term outcomes.
- Further research is needed, but current evidence supports prompt intervention based on established protocols.
Abstract:
This review provides an updated analysis of the main aspects involving the diagnosis and the management of children with acute ischemic stroke. Acute ischemic stroke is an emergency of rare occurrence in children (rate of incidence of 1/3500 live birth in newborns and 1-2/100,000 per year during childhood with peaks of incidence during the perinatal period, under the age of 5 and in adolescence). The management of ischemic stroke in the paediatric age is often challenging because of pleomorphic age-dependent risk factors and aetiologies, high frequency of subtle or atypical clinical presentation, and lacking evidence-based data about acute recanalization therapies. Each pediatric tertiary centre should activate adequate institutional protocols for the optimization of diagnostic work-up and treatments.Conclusion: The implementation of institutional standard operating procedures, summarizing the steps for the selection of candidate for neuroimaging among the ones presenting with acute neurological symptoms, may contribute to shorten the times for thrombolysis and/or endovascular treatments and to improve the long-term outcome. What is Known: •Acute ischemic stroke has a higher incidence in newborns than in older children (1/3500 live birth versus 1-2/100,000 per year). •Randomized clinical trial assessing safety and efficacy of thrombolysis and/or endovascular treatment were never performed in children What is New: •Recent studies evidenced a low risk (2.1% of the cases) of intracranial haemorrhages in children treated with thrombolysis. •A faster access to neuroimaging and hyper-acute therapies was associated with the implementation of institutional protocols for the emergency management of pediatric stroke.
