Advances in the diagnosis of pediatric arterial ischemic stroke - imaging and beyond
Nicola Dorothy Fearn1,2,3, Bruce C V Campbell4,5, Joseph Yuan-Mou Yang2,3,6
1Department of Neurology, The Royal Children's Hospital, Melbourne, Australia.
Insights
Timely diagnosis of pediatric arterial ischemic stroke (AIS) is crucial. Advances in neuroimaging and stroke pathways improve diagnosis, but integration with adult care and telemedicine are key for future progress.
Area of Science:
- Pediatric neurology
- Neurocritical care
- Vascular neurology
Background:
- Pediatric arterial ischemic stroke (AIS) is a major cause of neurological disability and death.
- Mortality rates for pediatric AIS range from 2% to 9%.
- Timely diagnosis and treatment are essential for improving outcomes in pediatric AIS.
Purpose of the Study:
- To review advances in reperfusion therapies for pediatric AIS.
- To highlight progress in acute and advanced neuroimaging techniques.
- To discuss the development of pediatric stroke pathways and understanding of AIS etiology and genetics.
Main Methods:
- A narrative review of relevant literature.
- Comprehensive search of PubMed, Medline, and EMBASE databases.
- Inclusion of published guidelines up to March 2025.
Main Results:
- Pediatric AIS presents challenges due to rarity, diagnostic complexity, and systemic barriers.
- Imaging advancements and streamlined stroke pathways are reducing diagnosis times.
- Future improvements depend on integrating pediatric care with adult systems, telemedicine, and perfusion imaging expertise.
Conclusions:
- Continued research into pediatric neurovascular genetics and advanced imaging will enable personalized stroke risk management.
- Enhanced collaboration and technological integration are vital for optimizing pediatric AIS care.
- Addressing system-level barriers is critical for improving patient outcomes.
Introduction:
Arterial ischemic stroke (AIS) represents a significant cause of neurological morbidity and mortality in the pediatric population, with reported mortality rates ranging from 2% to 9%. The growing evidence supporting the efficacy and safety of reperfusion therapies in pediatric AIS underscores the critical importance of timely and accurate diagnosis. There are many barriers to achieving this, including a lack of clinical recognition and diagnostic imaging delays.
Areas Covered:
This narrative review highlights key advances in reperfusion therapies, acute neuroimaging, advanced imaging, and the development of stroke pathways. It explores the growing understanding of the etiology and genetics of childhood AIS. A comprehensive literature search was performed using PubMed, Medline, and EMBASE for relevant studies and reports, as well as reviewing published guidelines available through March 2025.
Expert Opinion:
Pediatric AIS remains challenging due to its infrequent occurrence, diagnostic complexity, and system-level barriers. Advances in imaging and development of streamlined pediatric stroke pathways are shortening the time to diagnosis, but future advances will rely on integration within established adult systems of care, the use of telemedicine and the development of pediatric perfusion imaging expertise. Evolving knowledge of pediatric neurovascular genetics and secondary imaging modalities will lead to tailored management of conditions with stroke risk.
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