Management of Stroke in Infants and Children

Abstract

Purpose— The purpose of this statement is to review the literature on childhood stroke and to provide recommendations for optimal diagnosis and treatment. This statement is intended for physicians who are responsible for diagnosing and treating infants, children, and adolescents with cerebrovascular disease. Methods— The Writing Group members were appointed by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee. The panel included members with several different areas of expertise. Each of the panel’s recommendations was weighted by applying the American Heart Association Stroke Council’s Levels of Evidence grading algorithm. After being reviewed by panel members, the manuscript was reviewed by 4 expert peer reviewers and by members of the Stroke Council Leadership Committee and was approved by the American Heart Association Science Advisory and Coordinating Committee. We anticipate that this statement will need to be updated in 4 years. Results— Evidence-based recommendations are provided for the prevention of ischemic stroke caused by sickle cell disease, moyamoya disease, cervicocephalic arterial dissection, and cardiogenic embolism. Recommendations on the evaluation and management of hemorrhagic stroke also are provided. Protocols for dosing of heparin and warfarin in children are suggested. Also included are recommendations on the evaluation and management of perinatal stroke and cerebral sinovenous thrombosis in children.

Efficiency of transcatheter patent foramen ovale closure in children after paradoxical embolism events

“…Also, relation to prothrombotic disorders is raised in PFO patients with cerebral EE. Furthermore, recurrence of stroke is estimated in this age group at 25-30% [19,20].…”

“…Although AF is a rare cardiac cause of stroke in children, in opposition to congenital heart lesions or valvular diseases [24], its presence is associated with high risk of stroke, and both increased mortality and stroke recurrence [25].…”

Pediatric Neurocritical Care

“…Recommendations and treatment guidelines have largely been extrapolated from adult data. Three guidelines exist to guide the management of pediatric stroke, including the American College of Chest Physicians Guidelines [126], the American Heart Association Guidelines [127], and the Royal College of Physicians guidelines from the United Kingdom. Recommendations in these guidelines are based on an expert and consensus opinion, and in some instances are diverging in their interpretation of the data and on specific clinical management points [128].…”

Acidentes vasculares encefálicos em pediatria

“…Perinatal and neonatal strokes give an incidence of 10 to 18 in 100,000 live births, while studies have reported rates of up to 63/100,000. 7 In view of its different clinical manifestations, its diverse causes and low suspicion for stroke in pediatrics, these data may underestimate the true incidence of stroke in this group. Stroke recurrence in children can reach 20%, and in the presence of multiple risk factors recurrence can be as high as 42%.…”

“…81 The anticoagulant therapy, either in the acute phase of stroke or for the chronic management, is one of the major issues described in the 2008 guidelines in Chest 82 and the American Heart Association (AHA). 7 In AIS, the Chest guidelines recommend use of UFH or LMWH or aspirin (1 mg/kg/day) until cardioembolic and dissection subtypes of stroke are excluded. The AHA recommendation addresses use of UFH or LMWH up to 1 week until the cause is determinate.…”