Pediatric stroke: From emergent evaluation to rehabilitation

Pediatric stroke, though less common than adult stroke, is a significant cause of morbidity and mortality in children, affecting neonates, infants, and adolescents. Strokes in children could be due to ischemic, hemorrhagic, or venous-thrombotic events. Timely recognition and intervention to optimize neurologic outcomes and minimize long-term disability is most critical. Clinical symptoms are dependent on location of the stroke, but pediatric-specific challenges include higher prevalence of stroke mimics and more frequent seizures. Rapid diagnosis hinges on detailed history, neurologic examination, and emergent imaging, with MRI and angiography preferred for evaluating ischemia and vascular anomalies. Hyperacute treatments include intravenous thrombolysis and mechanical thrombectomy. Risk factors are often multifactorial, including congenital heart disease, sickle cell disease, and thrombophilia. Acute complications may involve cerebral edema, hemorrhagic conversion, and post-stroke epilepsy. Rehabilitation is essential and begins early in the intensive care unit. A multidisciplinary team-including physical, occupational, and speech therapists alongside physiatrists-supports recovery. Rehabilitation intervention includes uses of orthoses to improve function, prevent complications, impairment specific treatment including constraint-induced movement therapy (CIMT) and goal-oriented hypertonia management. Cognitive and communication impairments also require tailored therapies and school reintegration planning. Although neural plasticity offers potential for recovery, many children experience persistent motor, cognitive, and psychosocial deficits. Early, aggressive rehabilitation and coordinated outpatient care are key to maximizing functional outcomes and improving long-term quality of life.