Advances in the Diagnosis and Treatment of Pediatric Arterial Ischemic Stroke

Abstract

Though rare, stroke in infants and children is an important cause of mortality and chronic morbidity in the pediatric population. Neuroimaging advances and implementation of pediatric stroke care protocols have led to the ability to rapidly diagnose stroke and in many cases determine the stroke etiology. Though data on efficacy of hyperacute therapies, such as intravenous thrombolysis and mechanical thrombectomy, in pediatric stroke are limited, feasibility and safety data are mounting and support careful consideration of these treatments for childhood stroke. Recent therapeutic advances allow for targeted stroke prevention efforts in high-risk conditions, such as moyamoya, sickle cell disease, cardiac disease, and genetic disorders. Despite these exciting advances, important knowledge gaps persist, including optimal dosing and type of thrombolytic agents, inclusion criteria for mechanical thrombectomy, the role of immunomodulatory therapies for focal cerebral arteriopathy, optimal long-term antithrombotic strategies, the role of patent foramen ovale closure in pediatric stroke, and optimal rehabilitation strategies after stroke of the developing brain. Supplementary Information The online version contains supplementary material available at 10.1007/s13311-023-01373-5.

Association between SARS-CoV-2 Seropositivity and Severity of Out-of-Hospital Acute Ischemic Stroke Following Asymptomatic/Mild COVID-19 in Children

“…This highlights the need for better education and training of health care professionals about the presentation of pediatric stroke, its risk factors, and its relation with other diseases, such as COVID-19, to ensure timely diagnosis and management as well as preventive measures of stroke in children. 15,40 Intravenous thrombolysis has not been wellestablished in the management guidelines for pediatric AIS due to the lack of solid evidence from pediatric randomized controlled trials, but it seems to have similar safety as in adults. 40 However, the effectiveness of tPA for pediatric AIS, its optimal age-/weight-based dosing, and its ideal therapeutic time window remain unclear.…”

“…15,40 Intravenous thrombolysis has not been wellestablished in the management guidelines for pediatric AIS due to the lack of solid evidence from pediatric randomized controlled trials, but it seems to have similar safety as in adults. 40 However, the effectiveness of tPA for pediatric AIS, its optimal age-/weight-based dosing, and its ideal therapeutic time window remain unclear. On the other hand, antithrombotic therapy remains the cornerstone for secondary prevention after pediatric AIS as long as the risk of recurrence outweighs the risk of hemorrhagic transformation of cerebral infarction.…”

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

“…75,76 Children with acute stroke are often admitted to the PICU for close neuromonitoring and implementation of neuroprotective measures for at least 24 hours while undergoing a thorough evaluation to identify causative factors. For a comprehensive discussion on pediatric stroke, the reader is referred to recent reviews 75,83 and to the 2019 AHA/ASA Statement on Management of Stroke in Neonates and Children, 76 summarized in ►Table 4.…”

Decompressive hemicraniectomy in pediatric malignant arterial ischemic stroke: a case-based review

“…Definite diagnosis of malignant stroke is made after clinical suspicion by brain CT scan or magnetic resonance imaging (MRI) with the visualization of an acute infarct area with restricted diffusion on DWI and mass effect [1,[3][4][5][6]62].…”