Neuropediatrics 2016; 47 - P02-06
DOI: 10.1055/s-0036-1583632

Thrombolysis in Pediatric Arterial Ischemic Stroke: Report of Two Young Children

C. M. Wernicke 1, G. Balling 2, C. Makowski 1, K. Beutel 1, M. Pringsheim 2, 3, M. Staudt 3, V. Mall 1, H. Juenger 1
  • 1Kinderklinik der TU München, Germany
  • 2Deutsches Herzzentrum Muenchen, Germany
  • 3Schön Klinik Vogtareuth, Germany

Background/Purpose: Although less common than in adults, pediatric stroke occurs in 0.6–7.9/100.000 children between 1 month and 18 years of age, resulting in significant morbidity and mortality. The etiologies and risk factors in children differ from those in adults—the most frequent conditions in children are arteriopathy, cardiac disorders and infection. For treatment with thrombolysis, the efficacy, safety and dose of rt-PA have not yet been established as no complete randomized controlled trials have been performed. Currently, there is no recommendation for thrombolysis in children less than 18 years of age with ischemic stroke.

Methods and Results: In Patient 1 (11 months old) and Patient 2 (2 years) with congenital complex heart defects, thrombolysis was performed 3 and 4 hours after onset of symptoms after early MRI-based diagnosis of thromboembolic stroke with (subtotal) occlusion of the middle cerebral artery. Both patients underwent systemic thrombolysis with rt-PA (Patient 1: 1 mg/kg over 24 hours, no bolus was given due to the risk of bleeding after cardiac catheterization; Patient 2: 0.1 mg/kg over 1 hour, followed by 0.9 mg/kg over 24 hours) without complications. In both patients, the occlusion of the middle cerebral artery was not more visible in the MRI after thrombolysis.

Conclusion: We demonstrate that, after critical evaluation of contraindications, systemic thrombolysis with rt-PA can be safe even in very young children with arterial thromboembolic stroke.