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Be aware of childhood stroke: Proceedings from EPNS Webinar
Gabriela Oesch1, Robin Münger2, Maja Steinlin1
1Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Insights
Childhood arterial ischaemic stroke (AIS) is increasing, driven by multifactorial causes. Early diagnosis and intervention, including genetic testing and prompt treatment, are crucial for managing this growing pediatric health concern.
Area of Science:
- Pediatrics
- Neurology
- Vascular Medicine
Background:
- Childhood arterial ischaemic stroke (AIS) incidence is rising globally, particularly in developing nations.
- Multifactorial causes, including infections, sickle cell disease, congenital heart defects, and genetic factors, contribute to pediatric AIS.
- Distinguishing AIS from stroke mimics like migraines and seizures is clinically challenging.
Purpose of the Study:
- To provide a comprehensive overview of the current understanding of childhood AIS.
- To highlight key aspects of AIS etiology, diagnosis, and management in children.
- To emphasize the importance of early intervention and rehabilitation for improved outcomes.
Main Methods:
- Review of current literature on childhood arterial ischaemic stroke.
- Analysis of etiological factors, diagnostic pathways, and therapeutic strategies.
- Emphasis on the role of national guidelines and genetic testing.
Main Results:
- Childhood AIS is multifactorial, with increasing incidence linked to improved diagnostics and risk factors.
- Genetic testing aids in identifying underlying conditions for prognosis and management.
- Early intervention, including mechanical thrombectomy, antiplatelet/anticoagulant therapy, and rehabilitation, is critical.
Conclusions:
- Childhood AIS is a significant and growing pediatric health issue.
- A thorough understanding of risk factors, diagnostic approaches, and timely management is essential.
- Optimized patient care requires a multidisciplinary approach, from diagnosis through rehabilitation.
Abstract:
Childhood arterial ischaemic stroke (AIS) is a significant health concern with increasing incidence. This review aims to provide an overview of the current understanding of childhood AIS. The incidence of childhood AIS is on the rise especially in developing countries, likely due to improved awareness and diagnostic capabilities. Aetiology of childhood AIS is multifactorial, with both modifiable risk factors and genetic predisposition playing important roles. Identifying and addressing these risk factors, such as infection, sickle cell disease, and congenital heart defects, is essential in prevention and management. Identifying underlying conditions through genetic testing is important for appropriate management and long-term prognosis. Clinically, distinguishing stroke from stroke mimics can be challenging. Awareness of important stroke mimics, including migraines, seizures, and metabolic disorders, is crucial to avoid misdiagnosis and ensure appropriate treatment. The diagnostic approach to childhood AIS involves a comprehensive "chain of care," including initial assessment, neuroimaging, and laboratory investigations. National guidelines play a pivotal role in standardizing and streamlining the diagnostic process, ensuring prompt and accurate management. Early intervention is critical in the management of childhood AIS. Due to the critical time window, the question if mechanical thrombectomy is feasible and beneficial should be addressed as fast as possible. Early initiation of antiplatelet or anticoagulation therapy and, in select cases, thrombolysis can help restore blood flow and minimize long-term neurological damage. Additionally, rehabilitation should start as soon as possible to optimize recovery and improve functional outcomes. In conclusion, childhood AIS is a growing concern. Understanding the increasing incidence, age distribution, risk factors, clinical presentation, diagnostic approach, and management strategies is crucial for optimized management of these patients.
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