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Pediatric arterial ischemic stroke — Clinical Guidelines

Overview

Arterial ischemic stroke (AIS) in pediatric patients is a significant cause of acquired brain injury, affecting motor function, cognitive abilities, and quality of life long-term 1 3.

Diagnosis

Key Diagnostic Criteria: Radiologically confirmed stroke in children aged ≤16 years 3.

Recommended Tests: Neurological evaluation, neuroimaging (MRI/CT), echocardiography, and assessment for risk factors including cardiac disorders 3 5.

Grading: Utilization of the Pediatric Stroke Outcome Measure (PSOM) for neurological outcomes 1.

Management

First-Line Treatments: Antithrombotic therapy (e.g., anticoagulants, antiplatelet agents) with careful monitoring for complications 7.

Adjunctive Treatments: Rehabilitation focusing on motor skills, cognitive, and communication therapies 1 2.

Specific Considerations: Management tailored based on stroke subtype and underlying causes (e.g., ACTA2 mutations, cardiac disorders) 4 5.

Special Populations

Pediatrics: Higher incidence in infants and adolescents; motor and cognitive outcomes significantly impacted long-term 1 3 7.

Risk Factors: Neonates and preschool children show higher rates of motor impairment; cardiac disorders are prevalent 1 5.

Key Recommendations

Assess motor, cognitive, and communication outcomes at home to capture comprehensive long-term effects (Evidence: Moderate 2).

Focus on early identification and management of cardiac risk factors in pediatric stroke patients (Evidence: Moderate 5).

Implement prospective longitudinal studies to better understand natural history and prognostic factors in pediatric AIS (Evidence: Expert opinion 6).

Monitor for neurological sequelae, as they are present in over half of pediatric stroke cases (Evidence: Moderate 7).

Consider ACTA2 mutations in the differential diagnosis, especially with characteristic imaging findings (Evidence: Weak 4).

References

1 Cooper AN, Anderson V, Greenham M, Hearps S, Hunt RW, Mackay MT et al.. Motor function daily living skills 5 years after paediatric arterial ischaemic stroke: a prospective longitudinal study. Developmental medicine and child neurology 2019. link 2 Edwards H, Dunlop M, Mallick A, O'Callaghan F. Outcomes following childhood arterial ischaemic stroke: a Delphi Consensus on what parents want from future research. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society 2015. link 3 Mallick AA, Ganesan V, Kirkham FJ, Fallon P, Hedderly T, McShane T et al.. Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study. The Lancet. Neurology 2014. link70290-4) 4 Amans MR, Stout C, Fox C, Narvid J, Hetts SW, Cooke DL et al.. Cerebral arteriopathy associated with Arg179His ACTA2 mutation. Journal of neurointerventional surgery 2014. link 5 Dowling MM, Hynan LS, Lo W, Licht DJ, McClure C, Yager JY et al.. International Paediatric Stroke Study: stroke associated with cardiac disorders. International journal of stroke : official journal of the International Stroke Society 2013. link 6 Bernard TJ, Armstrong-Wells J, Goldenberg NA. The institution-based prospective inception cohort study: design, implementation, and quality assurance in pediatric thrombosis and stroke research. Seminars in thrombosis and hemostasis 2013. link 7 Tuckuviene R, Christensen AL, Helgestad J, Johnsen SP, Kristensen SR. Paediatric arterial ischaemic stroke and cerebral sinovenous thrombosis in Denmark 1994-2006: a nationwide population-based study. Acta paediatrica (Oslo, Norway : 1992) 2011. link

Pediatric arterial ischemic stroke