Neuropediatrics 2012; 43(01): 001-009
DOI: 10.1055/s-0032-1307449
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Clinical Approach to Arterial Ischemic Childhood Stroke: Increasing Knowledge over the Last Decade

Maja Steinlin
1  Department of Neuropaediatrics, University Children's Hospital, Bern, Switzerland
› Author Affiliations
Further Information

Publication History

18 April 2011

03 February 2012

Publication Date:
19 March 2012 (online)

Abstract

Childhood stroke is increasingly being recognized as an important burden not only for affected children and families, but also for socioeconomic reasons. A primary problem is delayed diagnosis, due to the many mimics of childhood stroke, and the variety of manifesting symptoms. The most important is hemiparesis (with/without dysphasia or facial palsy), but ataxia, seizures, and many more are also possible. Suspicion of stroke has to be ascertained by neuroimaging, gold standard being (diffusion weighted) magnetic resonance. Risk factors are multiple, but their presence might help to increase the suspicion of stroke. The most important factors are infectious/parainfectious etiologies, frequently possibly manifesting by transient focal cerebral arteriopathy (FCA). Cardiological underlying problems are the second most important. Arteriopathies can be detected in about half of the children, besides FCA and dissection and MoyaMoya disease are the most important. Hereditary coagulopathies increase the risk of stroke. There is still a controversy on best treatment in children: platelet antiaggregation and heparinization are used about equally. Thrombolysis is being discussed increasingly. Severity of symptoms at manifestation and on follow-up are not less significant in children than in young adults. About two-third of the children have significant residual neurological problems and a majority cognitive and behavior problems.