Definitive Diagnostic Evaluation of the Child With Arterial Ischemic Stroke and Approaches to Secondary Stroke Prevention

Abstract

In children with arterial ischemic stroke (AIS), the definitive diagnosis of stroke subtype and confirmation of stroke etiology is necessary to mitigate stroke morbidity and prevent recurrent stroke. The common causes of AIS in children are sharply differentiated from the common causes of adult AIS. A comprehensive, structured diagnostic approach will identify the etiology of stroke in most children. Adequate diagnostic evaluation relies on advanced brain imaging and vascular imaging studies. A variety of medical and surgical secondary stroke prevention strategies directed at the underlying cause of stroke are available. This review aims to outline strategies for definitive diagnosis and secondary stroke prevention in children with AIS, emphasizing the critical role of neuroimaging.

Mechanical disorders of the cervicocerebral circulation in children and young adults

“…14 VA dissections are frequently unrecognized due to the underuse of cervical vascular imaging in pediatric clinical practice. 15 Nonetheless, studies still show that non-traumatic VA dissection is responsible for the majority of childhood posterior circulation stroke and that BHS accounts for the majority of childhood non-traumatic VA dissection. 2 BHS most commonly affects children between the ages of 2 and 16 years (mean 9-10 years), but children aged 1 year or younger can also be affected.…”