Arterial Ischemic Stroke in Children: Navigating Diagnostic and Management Pathways

Pediatric stroke is garnering increased attention due to its rising incidence and significant impact on affected children, families, and the health care system. Arterial ischemic stroke (AIS) is a major subtype of pediatric stroke and often results from arterial occlusion. Diagnosis and treatment of acute ischemic stroke in children pose unique challenges, primarily because of nonspecific symptoms, lack of pediatric-focused imaging protocols, distinct causes (compared with in adults), and the large number of stroke mimics. Despite several advances in imaging and treatment strategies, the emergency management of pediatric AIS remains challenging and varies across health care centers. This inconsistency underscores the need for further research to establish standardized assessment protocols and neuroimaging guidelines and refine therapeutic strategies. The authors outline key aspects of pediatric AIS, including early recognition, emergency neuroimaging techniques, an abbreviated MRI protocol, and management pathways in the emergency department. An abbreviated MRI protocol is critical because it provides high sensitivity for detecting ischemia and aids in identifying stroke causes as well as accurately detecting stroke mimics and significantly minimizing the necessity for prolonged sedation or anesthesia. The authors emphasize the value of a multidisciplinary streamlined approach to management of pediatric AIS to ensure the best possible outcomes. ^©RSNA, 2025 Supplemental material is available for this article. See the invited commentary by Fung and Rutten in this issue.