Cerebrovascular disorders.
Arterial ischemic stroke is being recognized more commonly in the pediatric population. The etiologies differ greatly from those seen in adults. The most common etiologies are congenital heart disease and sickle cell disease. Children may present with or without hemiparesis and may have fever, headache, and depressed level of consciousness. A high index of suspicion is needed to diagnose stroke. Although clinical studies are scarce in children, besides early diagnosis, early specialized care with careful attention to detail ensuring adequate oxygenation and ventilation, prevention of hyperthermia and seizures, and maintenance of blood pressure and metabolic balance are important and likely improve outcome in these children. Selective children may also benefit from anticoagulant therapy, and, as the interval to diagnosis decreases, thrombolytic therapy may become an option although safety data are required. Children with acute stroke should be rapidly transported to and cared for in a pediatric center with a specialized stroke team or access to acute stroke protocols.
Hutchison
James S
JS
Department of Critical Care and Pediatrics, Hospital for Sick Children, and Interdepartmental Division of Critical Care, Faculty of Medicine, University of Toronto, Toronto, Canada.
Ichord
Rebecca
R
Guerguerian
Anne-Marie
AM
Deveber
Gabrielle
G
D000328:Adult; D000755:Anemia, Sickle Cell / Q000209:etiology* / Q000628:therapy; D001786:Blood Glucose / Q000502:physiology; D001929:Brain Edema / Q000209:etiology / Q000628:therapy; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D002648:Child; D005334:Fever / Q000517:prevention & control; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology / Q000628:therapy; D008991:Monitoring, Physiologic; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology / Q000628:therapy; D014691:Ventilation
D001786:Blood Glucose