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Ischemic stroke in children: Evaluation, initial management, and prognosis

Sabrina E Smith, MD, PhD
Christine Fox, MD, MAS
Section Editors
Scott E Kasner, MD
Douglas R Nordli, Jr, MD
Deputy Editor
John F Dashe, MD, PhD


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: Classification, manifestations, and diagnosis" and "Cerebral venous thrombosis: Etiology, clinical features, and diagnosis".)


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 [1].

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 [2], 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 [3].

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Literature review current through: Nov 2017. | This topic last updated: Jun 27, 2017.
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