Ischemic stroke in children: Evaluation, initial management, and prognosis
- Sabrina E Smith, MD, PhD
Sabrina E Smith, MD, PhD
- Pediatric Neurologist
- Kaiser Permanente Oakland Medical Center
- Christine Fox, MD, MAS
Christine Fox, MD, MAS
- Assistant Professor of Neurology
- University of California, San Francisco
- Section Editors
- Scott E Kasner, MD
Scott E Kasner, MD
- Section Editor — Stroke
- Professor of Neurology
- University of Pennsylvania School of Medicine
- Douglas R Nordli, Jr, MD
Douglas R Nordli, Jr, MD
- Section Editor — Pediatric Neurology
- Chief of Neurology
- Children’s Hospital Los Angeles
- Vice Chair of Neurology
- USC Keck School of Medicine
While more common in older adults, stroke also occurs in neonates, infants, children, and young adults, resulting in significant morbidity and mortality.
An overview of the evaluation, initial management, and prognosis of arterial ischemic stroke in children one month of age or older is provided here. Other aspects of ischemic stroke in children and young adults are reviewed elsewhere. (See "Ischemic stroke in children and young adults: Etiology and clinical features" and "Ischemic stroke in children: Secondary prevention" and "Stroke in the newborn" and "Etiology, clinical features, and diagnosis of cerebral venous thrombosis".)
Urgent evaluation and neuroimaging is important for confirming the diagnosis of acute arterial ischemic stroke (algorithm 1) because there are numerous conditions that can mimic ischemic stroke, particularly with regard to children .
Because the causes of stroke in children and young adults are varied, and because the presence of multiple risk factors for stroke increases recurrence risk , clinicians should conduct a thorough investigation for possible cardiac, vascular, and hematologic risk factors in all patients.
Stroke in children is a multifactorial disease, so the full diagnostic evaluation should be completed even if one risk factor is identified. In support of this, a case-control study of 38 children with underlying cardiac disease and ischemic stroke found more than one hemostatic abnormality consistent with a prothrombotic state in 10.5 percent of cases and in none of the 100 age-matched controls .
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- Laboratory studies
- - Hypercoagulable state evaluation
- - Vasculitis evaluation
- - MELAS evaluation
- INITIAL MANAGEMENT
- Supportive measures
- Thrombolysis and thrombectomy
- Initial antithrombotic treatment
- - Guidelines
- Acute treatment for specific causes of arterial ischemic stroke
- Recurrent ischemia
- SUMMARY AND RECOMMENDATIONS