title: Brain attacks and stroke in children.
abstract: Emergency physicians are often the first point of contact in children presenting with acute neurological disorders. Differentiating serious disorders, such as stroke, from benign disorders, such as migraine, can be challenging. Clinical assessment influences decision-making, in particular the need for emergent neuroimaging to confirm diagnosis. This review describes the spectrum of disorders causing 'brain attack' symptoms, or acute onset focal neurological dysfunction, with particular emphasis on childhood stroke, because early recognition is essential to improve access to thrombolytic treatments, which have improved outcomes in adults. Clues to diagnosis of specific conditions are discussed. Symptoms and signs, which discriminate stroke from mimics, are described, highlighting differences to adults. Haemorrhagic and ischaemic stroke have different presenting features, which influence choice of the most appropriate imaging modality to maximise diagnostic accuracy. Improvements in the care of children with brain attacks require coordinated approaches and system improvements similar to those developed in adults.
authors.affiliation: Department of Neurology.|Murdoch Childrens Research Institute, Parkville, Australia.|Florey Institute of Neurosciences and Mental Health.|Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Mackay
authors.affiliation: Murdoch Childrens Research Institute, Parkville, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Monagle
authors.affiliation: Emergency Department, Royal Children's Hospital.|Murdoch Childrens Research Institute, Parkville, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Franz E
authors.initials: FE
authors.lastname: Babl
mesh_terms: D000208:Acute Disease; D002648:Child; D000066491:Clinical Decision-Making; D003937:Diagnosis, Differential; D006801:Humans; D059906:Neuroimaging; D009483:Neuropsychological Tests; D000070316:Pediatric Emergency Medicine; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy
keywords: brain attack; cerebrovascular disease; childhood stroke; clinical neurology; emergency; neurological