Treatment of childhood arterial ischemic stroke.
Traditional risk factors associated with adult arterial ischemic stroke (AIS; ie, hypertension, hyperlipidemia, diabetes, smoking, and atherosclerosis) are relatively rare in children. Childhood AIS is instead associated with a variety of conditions including cerebral arteriopathies, congenital heart disease, infection, head and neck trauma, sickle cell anemia, and prothrombotic abnormalities. Although the pathophysiology and outcomes of adult AIS differ significantly from those in childhood AIS, therapeutic management remains similar, largely because of the paucity of evidence from devoted pediatric observational studies and clinical trials. The purpose of this article is to review the current guidelines and evidence in the treatment of childhood AIS, within the context of that which exists in adult AIS. Medical management of hypoxia, hyperglycemia, fever, blood pressure, and increased intracranial pressure has been insufficiently investigated in childhood stroke, resulting in a lack of guidance in these areas. Although acute antithrombotic management in childhood AIS has received relatively greater attention in published recommendations, it is based almost exclusively on consensus and expert opinion, and differs considerably among existing pediatric guidelines. Rehabilitation therapy in childhood AIS has great potential for meaningful improvements in long-term outcomes, especially given the plasticity of the young brain; however, little guidance for rehabilitative measures is provided by published recommendations. Ongoing and future multicenter cohort study efforts, and ultimately devoted pediatric clinical trials, will be essential to establish comprehensive evidence-based guidelines for the treatment of childhood AIS.
Bernard
Timothy J
TJ
Department of Pediatrics, University of Colorado, The Children's Hospital, Denver, CO 80045, USA. timothy.bernard@uchsc.edu
Goldenberg
Neil A
NA
Armstrong-Wells
Jennifer
J
Amlie-Lefond
Catherine
C
Fullerton
Heather J
HJ
D000367:Age Factors; D002545:Brain Ischemia / Q000628:therapy*; D002536:Cerebral Arteries / Q000473:pathology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D006801:Humans; D009462:Neurology / Q000379:methods / Q000592:standards* / Q000639:trends; D010372:Pediatrics / Q000379:methods / Q000592:standards* / Q000639:trends; D026741:Physical Therapy Modalities / Q000592:standards / Q000639:trends; D017410:Practice Guidelines as Topic; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods / Q000592:standards / Q000639:trends