Early, modern way of diagnosis and treatment of children’s stroke

Stroke has been increasingly recognized in children in recent years, but diagnosis and management can be difficult because of the diversity of underlying risk factors and the absence of a uniform treatment approach. The World Health Organization definition of stroke (a clinical syndrome of rapidly developing focal or global disturbance of brain function lasting >24 hours or leading to death with no obvious nonvascular cause) is far from ideal for children. Children with symptoms compatible with a transient ischemic attack (TIA), for example, commonly have a brain infarction shown by brain imaging despite the transient nature of their symptoms. Children with cerebral venous sinus thrombosis (CVST) commonly present with headache or seizures. “Stroke-like episodes” without an obvious vascular cause may occur in migraine or metabolic disease but may require specific treatment. Prior illness (e.g., infection) or events (e.g., head trauma) need not preclude a diagnosis of stroke. Although extra-axial hematomas, neonatal intraventricular hemorrhages (IVHs), and periventricular leukomalacia arise from cerebrovascular dysfunction in a broad sense, they are not considered in detail here. Pediatric stroke affects 25 in 100,000 newborns and 12 in 100,000 children under 18 years of age. High rate of complications leading to invalidation of children with acute disorder of the blood circulation in the brain and recurrence of stroke in 20% of cases require specific method in determining it at early stages. This pathology leads to death in 14% of cases and there is stable neurologic deficit in 70% of cases. The best prevention against stroke is control and management of risk factors. There are 2 main types of stroke: ischemic and haemorrhagic. Pediatric arterial ischemic stroke (AIS) is an important cause of long-term morbidity and is among 1 of the top 10 reasons for death in children [1, 2]. Although it occurs in 2 to 3 children per 100,000 children per year, with an increased incidence of about 1 in 4000 during the perinatal or neonatal period, accurate diagnosis is commonly delayed or missed [2]. As such, increasing recognition of the signs and symptoms of this significant cause of morbidity and mortality in children is critical to improving diagnosis and providing optimal treatment. Pediatric hemorrhagic stroke has an incidence of 1.1 per 100,000 person-years and encompasses subarachnoid hemorrhage and intracerebral (parenchymal) hemorrhage. Given the rarity of the condition and the under-recognition of cerebrovascular disease in children, it is not surprising that hemorrhagic stroke in children has not been well studied. This thesis will focus on information needed to move the field forward in terms of predicting hemorrhagic stroke etiology and outcome, as well as on improving treatment options [27]. With an incidence of 2–3/100,000 children, stroke is among the top ten causes of death in childhood [28, 29], and is as common as brain tumor in children [30]. A study of a California-wide hospital discharge database found an incidence rate of 1.1 per 100,000 person-years for hemorrhagic stroke and 1.2 per 100,000 person-years for ischemic stroke [31]. Thus, nearly half of pediatric strokes are hemorrhagic. Typically, the term “hemorrhagic stroke” (HS) includes spontaneous intraparenchymal hemorrhage (IPH) and non-traumatic subarachnoid hemorrhage (SAH). Patients with traumatic IPH, primary subdural or epidural hematomas, or hemorrhagic transformation of ischemic stroke are usually not considered to have a hemorrhagic stroke [32, 33]. For the purposes of this article, we will focus on IPH, the most common type of HS. Non-traumatic SAH is most often due to intracranial aneurysm and is evaluated and treated differently, though like IPH, recommendations for childhood SAH are based on the adult literature. Two recent pediatric intracranial aneurysm case series and reviews of the literature are available [34, 35].