Arterial ischemic stroke in non-neonate children: Diagnostic and therapeutic specificities

Kossorotoff, Manoëlle; Chabrier, Stéphane; Dong, Kai; Tich, Sylvie Nguyen The; Dinomais, Mickaël

doi:10.1016/j.neurol.2019.03.005

Cited by 10 publications

(12 citation statements)

References 95 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…4 Awareness about initial symptoms, using MRI first and adapted management in the acute phase, individualised thrombolysis or recanalisation treatment strategies, antithrombotic and anticoagulation therapy are the key elements to improve paediatric management and outcomes. 5 Our study provides multicentre data of children who had an AIS and HS and to some extent reflected the current medical care situation in paediatric stroke in China. The result regarding sex ratio was similar to that reported in the literature.…”

Section: Discussionmentioning

confidence: 92%

“…Paediatric stroke is a severe condition, with potentially devastating consequences such as development (motor, language and mentality) and behavioural disabilities or epilepsy 4. Awareness about initial symptoms, using MRI first and adapted management in the acute phase, individualised thrombolysis or recanalisation treatment strategies, antithrombotic and anticoagulation therapy are the key elements to improve paediatric management and outcomes 5…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Childhood strokes in China describing clinical characteristics, risk factors and performance indicators: a case-series study

et al. 2021

View full text Add to dashboard Cite

AimTo investigate clinical characteristics, risk factors (RFs), neurologic deficits and medical care provided in children who had a stroke in China.MethodsWe conducted a retrospective case-series study using the medical records of children aged 1 month to 18 years with arterial ischaemic stroke (AIS) or haemorrhagic stroke (HS) (with the entry codes I60, I61, I62, I63 (ICD-10)), who were admitted to different hospitals in Beijing, between January 2018 and December 2018. We obtained the following information from the charts: demographic characteristics, clinical presentations, RFs for paediatric stroke, laboratory examination, neuroimaging records and neurologic sequelae.ResultsWe identified 312 first admissions for stroke (172 AIS and 140 HS). The mean age at onset was 8.6±3.9 years for patients who had an AIS and 8 (5–13) years for patients who had an HS. There were more males than females in both groups (AIS: 59.88% vs 40.12%; HS: 52.14% vs 47.86%). A known aetiology was identified in 92.44% and 86.43% of patients who had an AIS and HS, respectively. The leading cause of AIS was cerebrovascular diseases including moyamoya (68.6%), while that for HS was arteriovenous malformation (51.43%). The most common initial clinical presentation was hemiplegia (86.05%) in patients who had an AIS and headache (67.86%) in patients who had an HS. The use of healthcare, including acute treatment (antithrombotic in 17.44%, anticoagulant in 5.23%) and secondary prevention (antithrombotic in 6.39%, anticoagulant in 1.16%), varied and was significantly lower among patients who had an AIS. The most common complications were epilepsy (22.09%) and pneumonia (4.65%) in patients who had an AIS and epilepsy (17.14%) and hydrocephalus (12.14%) in patients who had an HS. Neurological deficits occurred in 62.8% of patients who had an AIS and 72.86% of patients who had an HS.ConclusionCerebral arteriopathy was a major RF for both AIS and HS in children living in China. Large epidemiological studies are required to identify RFs to prevent stroke as well as appropriate interventions.

show abstract

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Childhood strokes in China describing clinical characteristics, risk factors and performance indicators: a case-series study

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Independent of age, the majority of children present with an acute focal neurological deficit such as acute hemiparesis, facial palsy and speech disturbance. 4,5,[7][8][9] Therefore, the "Face Arm Speech Time-FAST test"-developed as an early recognition tool for adult stroke, can also be used as a screening tool in childhood stroke with a satisfactory sensitivity of approximately 76%. 10 The sensitivity of the beFAST test (b ¼ balance, e ¼ eyes) may be even higher but has not been evaluated systematically so far.…”

Section: Clinical Presentationmentioning

confidence: 99%

Childhood Arterial Ischaemic Stroke: Clinical Presentation, Risk Factors and Management

Gerstl¹,

Bonfert²,

Heinen³

et al. 2020

Hamostaseologie

View full text Add to dashboard Cite

Childhood arterial ischaemic stroke (AIS) is a rare, but potentially life-threatening event which requires early diagnosis and adequate treatment. The reported significant time delay to childhood AIS diagnosis may be associated with low awareness, the more nonspecific clinical presentation as well as difficult clinical differentiation to more common “stroke mimics” and a less established “acute care structure” with delayed access to proper neuroimaging. Compared with adult stroke care, experiences with acute reperfusion therapies like thrombolysis and mechanical thrombectomy are promising but limited and not based on clinical trials. The etiological work-up is absolutely essential, as the child's individual risk profile determines acute management, secondary prevention, risk of recurrence and outcome. Follow-up care should be organized in a multidisciplinary setting covering all bio-psycho-social aspects to achieve the best integration of the child into its educational, later professional and social environments.

show abstract

“…Moyamoya arteriopathy is an important risk factor for pediatric arterial ischemic stroke. 13,14 Arteriopathies, in general, are the most frequent identifiable cause of pediatric stroke and also present the largest risk of stroke recurrence. 15,16 Because of the progressive nature of the disease, children with moyamoya arteriopathy are at high risk for recurrent stroke, sensorimotor deficits, and cognitive decline.…”

mentioning

confidence: 99%

Clinical Presentation and Stroke Incidence Differ by Moyamoya Etiology

Gatti¹,

Torriente

Sun³

2020

J Child Neurol

View full text Add to dashboard Cite

Introduction: Moyamoya arteriopathy, which can be idiopathic or associated with sickle cell disease, neurofibromatosis, Down syndrome, or cranial radiation therapy, is a progressive cerebral arteriopathy associated with high rates of incident and recurrent stroke. Little is known about how these subgroups differ with respect to clinical presentation, radiographic findings, stroke risk, and functional outcomes. Methods: Using ICD codes, we identified children ages 28 days to 18 years treated for moyamoya arteriopathy at our tertiary care center between 2003 and 2019. Demographic, clinical, and radiographic data were extracted from the medical record. The Pediatric Stroke Recurrence and Recovery Questionnaire was administered to consenting participants. Results: Sixty-nine patients met inclusion criteria (33 idiopathic, 18 sickle cell disease, 11 neurofibromatosis, 6 Down syndrome, 1 cranial radiation therapy). Median follow-up time was 7.7 years; 24 patients had at least 5 years of follow-up data. Frequency of stroke at presentation differed by subgroup ( P < .001). Of patients with at least 2 years of follow-up, 33 (55%) experienced stroke. The proportion of patients experiencing stroke differed by subgroup (50% of idiopathic cases, 72% of sickle cell disease, 11% of neurofibromatosis, and 100% of Down syndrome, P = .003). The frequency of bilateral versus unilateral disease ( P = .001) and stroke-free survival following presentation ( P = .01) also differed by subgroup. Conclusions: In this single-center cohort, moyamoya subgroups differed with respect to clinical and radiographic characteristics, with neurofibromatosis-associated moyamoya syndrome having a milder phenotype and Down syndrome–associated moyamoya portending a more aggressive course. These findings need confirmation in a larger, multi-center cohort with longer duration of follow-up.

show abstract

Arterial ischemic stroke in non-neonate children: Diagnostic and therapeutic specificities

Cited by 10 publications

References 95 publications

Childhood strokes in China describing clinical characteristics, risk factors and performance indicators: a case-series study

Childhood strokes in China describing clinical characteristics, risk factors and performance indicators: a case-series study

Childhood Arterial Ischaemic Stroke: Clinical Presentation, Risk Factors and Management

Clinical Presentation and Stroke Incidence Differ by Moyamoya Etiology

Contact Info

Product

Resources

About