Perspectives in neonatal and childhood arterial ischemic stroke.
Over the last decade considerable advances have been made in the identification, understanding and management of pediatric arterial ischemic stroke. Such increasing knowledge has also brought new perspectives and interrogations in the current acute and rehabilitative care of these patients. Areas covered: In developed countries, focal cerebral arteriopathy is one of the most common causes of arterial ischemic stroke in childhood and imaging features are well characterized. However, there are ongoing debates regarding its underlying mechanisms, natural evolution and proper management. The implementation of thrombolytic therapy in acute pediatric stroke has been shown to be efficient in anecdotal cases but is still limited by a number of caveats, even in large tertiary centers. Finally, neonatal stroke represents a unique circumstance of possible early intervention before the onset of any neurological disability but this appears meaningful only in a selective group of neonates. Expert commentary: While perinatal stroke, a leading cause of cerebral palsy, appears to be multifactorial, a large number of childhood ischemic stroke are probably essentially triggered by infectious factors leading to vessel wall damage. Current research is aiming at better identifying risk factors in both conditions, and to define optimal acute and preventive therapeutic strategies in order to reduce significant long-term morbidity.
a Pediatric Neurology Unit, Pediatric Subspecialties Service, Children's Hospital , Geneva University Hospitals , Geneva , Switzerland.
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Fluss
b LUNAM, Université d'Angers , Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) , EA7315 F-49000 , Angers , France.|c Département de Médecine Physique et de Réadaptation , CHU Angers , Angers , France.
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Dinomais
d French Center for Pediatric Stroke, Pediatric Neurology Department , APHP-Necker-Enfants Malades University Hospital , Paris , France.
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Kossorotoff
e Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, L'Escale , French Center for Pediatric Stroke/Service de Médecine Physique et de Réadaptation Pédiatrique , Bron , France.|f CNRS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive , Equipe Biostatistique Santé , Pierre-Bénite , France.
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Vuillerot
g Department of Pediatrics , French Polynesia Hospital , Tahiti , French Polynesia.|h Inserm U1090 Sainbiose and Université Lyon/Saint-Étienne , Dysfonction vasculaire et hémostase Team , Saint-Étienne , France.
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Darteyre
h Inserm U1090 Sainbiose and Université Lyon/Saint-Étienne , Dysfonction vasculaire et hémostase Team , Saint-Étienne , France.|i CHU Saint-Étienne , French Center for Pediatric Stroke/Pediatric Physical and Pediatric Rehabilitation Medicine Department & Inserm CIC1408 , Saint-Étienne , France.
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Chabrier
D002545:Brain Ischemia; D002561:Cerebrovascular Disorders; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000517:prevention & control / Q000628:therapy*; D012307:Risk Factors; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy
Stroke; arteriopathy; childhood; neonatal; thrombectomy; thrombolysis; varicella-zoster virus