title: Paediatric arterial ischemic stroke: acute management, recent advances and remaining issues.
abstract: Stroke is a rare disease in childhood with an estimated incidence of 1-6/100.000. It has an increasingly recognised impact on child mortality along with its outcomes and effects on quality of life of patients and their families. Clinical presentation and risk factors of paediatric stroke are different to those of adults therefore it can be considered as an independent nosological entity. The relative rarity, the age-related peculiarities and the variety of manifested symptoms makes the diagnosis of paediatric stroke extremely difficult and often delayed. History and clinical examination should investigate underlying diseases or predisposing factors and should take into account the potential territoriality of neurological deficits and the spectrum of differential diagnosis of acute neurological accidents in childhood. Neuroimaging (in particular diffusion weighted magnetic resonance) is the keystone for diagnosis of paediatric stroke and other investigations might be considered according to the clinical condition. Despite substantial advances in paediatric stroke research and clinical care, many unanswered questions remain concerning both its acute treatment and its secondary prevention and rehabilitation so that treatment recommendations are mainly extrapolated from studies on adult population. We have tried to summarize the pathophysiological and clinical characteristics of arterial ischemic stroke in children and the most recent international guidelines and practical directions on how to recognise and manage it in paediatric emergency.
authors.affiliation: Department of Translational Medicine-Section of Pediatrics, Federico II University, Naples, Italy. margherita.rosa@hotmail.it.
authors.forename: Margherita
authors.initials: M
authors.lastname: Rosa
authors.affiliation: Department of Paediatrics, Aldo Moro University of Bari, Bari, Italy. silvidelucia@hotmail.it.
authors.forename: Silvana
authors.initials: S
authors.lastname: De Lucia
authors.affiliation: Department of Paediatrics, University of Perouse, Perugia, Italy. victoria.rinaldi87@gmail.com.
authors.forename: Victoria Elisa
authors.initials: VE
authors.lastname: Rinaldi
authors.affiliation: Paediatric Migraine & Neurovascular diseases Unit, Department of Paediatrics, Robert Debré Hospital, Paris Diderot University, Sorbonne Paris Cité, Paris, France. julie.legal@aphp.fr.
authors.forename: Julie
authors.initials: J
authors.lastname: Le Gal
authors.affiliation: Paediatric Migraine & Neurovascular diseases Unit, Department of Paediatrics, Robert Debré Hospital, Paris Diderot University, Sorbonne Paris Cité, Paris, France. mariedesmarest@hotmail.fr.
authors.forename: Marie
authors.initials: M
authors.lastname: Desmarest
authors.affiliation: Department of Translational Medicine-Section of Pediatrics, Federico II University, Naples, Italy. claveropalu@hotmail.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Veropalumbo
authors.affiliation: Paediatric Emergency Department, Robert Debré Hospital, Paris Diderot University, Sorbonne Paris Cité, Paris, France. silviaromanello@yahoo.it.
authors.forename: Silvia
authors.initials: S
authors.lastname: Romanello
authors.affiliation: Paediatric Migraine & Neurovascular diseases Unit, Department of Paediatrics, Robert Debré Hospital, Paris Diderot University, Sorbonne Paris Cité, Paris, France. luigi.titomanlio@rdb.aphp.fr.|Paediatric Emergency Department, Robert Debré Hospital, Paris Diderot University, Sorbonne Paris Cité, Paris, France. luigi.titomanlio@rdb.aphp.fr.|Pediatric Emergency Department, INSERM U-1141 AP-HP Robert Debré University Hospital, 48, Bld Sérurier, 75019, Paris, France. luigi.titomanlio@rdb.aphp.fr.
authors.forename: Luigi
authors.initials: L
authors.lastname: Titomanlio
mesh_terms: D000208:Acute Disease; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D002648:Child; D019468:Disease Management; D014943:Global Health; D006801:Humans; D015994:Incidence; D059906:Neuroimaging / Q000379:methods*; D011788:Quality of Life; D015996:Survival Rate / Q000639:trends