Crossing the blood-brain barrier: clinical interactions between neurologists and hematologists in pediatrics - advances in childhood arterial ischemic stroke and cerebral venous thrombosis.
OBJECTIVE
The past year has marked a period of growing awareness of the need for improved diagnosis and treatment in children with arterial ischemic stroke (AIS) and cerebral sinus venous thrombosis (CSVT). Here we review these conditions, highlighting the importance of the intersection between hematologic abnormalities and pediatric stroke as they impact clinical management.


RESULTS
Recent multicenter cohort studies are beginning to clarify the incidence, risk factors, clinical course and outcomes of AIS and CSVT in children. Key findings include: diagnosis rests on adequate neuroimaging and is often delayed more than 24 h after symptom onset; multiple risk factors and inciting events are often involved; one or more prothrombotic risk factors are common; recurrence is common; and selected groups of patients benefit from anticoagulation, and less frequently, thrombolytic therapies.


CONCLUSIONS
Progress in caring for children with AIS and CSVT requires greatly improved awareness of cerebrovascular disease among primary providers, who are most often the first point of contact, more rapid and specific diagnosis using appropriate advanced neuroimaging technologies, comprehensive hematologic evaluation for inherited and acquired thrombophilias, and multidisciplinary approaches to treatment. Additional large cohort studies and clinical trials are greatly needed to further clarify these issues.
Witmer
Char
C
Department Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Ichord
Rebecca
R
D001778:Blood Coagulation Disorders / Q000235:genetics; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D002648:Child; D003952:Diagnostic Imaging; D006405:Hematology; D006801:Humans; D033183:Interdisciplinary Communication; D009462:Neurology; D010348:Patient Care Team; D010372:Pediatrics; D012008:Recurrence; D012307:Risk Factors; D012851:Sinus Thrombosis, Intracranial / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy