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Emergency Management of Ischemic Stroke in Children

Steinlin, Maja ; Mackay, Mark

In: Current Treatment Options in Neurology, 2015, vol. 17, no. 5, p. 1-14

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    Title
    • Emergency Management of Ischemic Stroke in Children
    Author
    • Steinlin, Maja. Paediatric Neurology, University Children's Hospital and Neurocentre, Inselspital Bern, 3010, Bern, Switzerland
    • Mackay, Mark. Department of Neurology, The Royal Children's Hospital Melbourne, 3 West Clinical Offices Room 3.062, 50 Flemington Road, Parkville, 3052, Melbourne, Victoria, Australia
    Document Type
    • Postprint
    Language
    • English
    Published in
    • Current Treatment Options in Neurology, 2015, vol. 17, no. 5, p. 1-14. Springer US; http://www.springer-ny.com
    Other Version
    OAI-PMH Identifier
    • oai:doc.rero.ch:332809
    Summary
    Opinion statement: Children who present with acute neurological symptoms suggestive of a stroke need immediate clinical assessment and urgent neuroimaging to confirm diagnosis. Magnetic resonance imaging (MRI) is the investigation of first choice due to limited sensitivity of computed tomography (CT) for detection of ischaemia. Acute monitoring should include monitoring of blood pressure and body temperature, and neurological observations. Surveillance in a paediatric high dependency or intensive care unit and neurosurgical consultation are mandatory in children with large infarcts at risk of developing malignant oedema or haemorrhagic transformation. Thrombolysis and/or endovascular treatment, whilst not currently approved for use in children, may be considered when stroke diagnosis is confirmed within 4.5 to 6h, provided there are no contraindications on standard adult criteria. Standard treatment consists of aspirin, but anticoagulation therapy is frequently prescribed in stroke due to cardiac disease and extracranial dissection. Steroids and immunosuppression have a definite place in children with proven vasculitis, but their role in focal arteriopathies is less clear. Decompressive craniotomy should be considered in children with deteriorating consciousness or signs of raised intracranial pressure.