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Current Treatment Options in Neurology
Published in: Current Treatment Options in Neurology 5/2015

01-05-2015 | Cerebrovascular Disorders (H Adams, Section Editor)

Emergency Management of Ischemic Stroke in Children

Authors: Maja Steinlin, MD, Mark T. Mackay, MBBS

Published in: Current Treatment Options in Neurology | Issue 5/2015

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Opinion statement

Children who present with acute neurological symptoms suggestive of a stroke need immediate clinical assessment and urgent neuroimaging to confirm diagnosis. Magnetic resonance imaging (MRI) is the investigation of first choice due to limited sensitivity of computed tomography (CT) for detection of ischaemia. Acute monitoring should include monitoring of blood pressure and body temperature, and neurological observations. Surveillance in a paediatric high dependency or intensive care unit and neurosurgical consultation are mandatory in children with large infarcts at risk of developing malignant oedema or haemorrhagic transformation. Thrombolysis and/or endovascular treatment, whilst not currently approved for use in children, may be considered when stroke diagnosis is confirmed within 4.5 to 6 h, provided there are no contraindications on standard adult criteria. Standard treatment consists of aspirin, but anticoagulation therapy is frequently prescribed in stroke due to cardiac disease and extracranial dissection. Steroids and immunosuppression have a definite place in children with proven vasculitis, but their role in focal arteriopathies is less clear. Decompressive craniotomy should be considered in children with deteriorating consciousness or signs of raised intracranial pressure.
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Metadata
Title
Emergency Management of Ischemic Stroke in Children
Authors
Maja Steinlin, MD
Mark T. Mackay, MBBS
Publication date
01-05-2015
Publisher
Springer US
Published in
Current Treatment Options in Neurology / Issue 5/2015
Print ISSN: 1092-8480
Electronic ISSN: 1534-3138
DOI
https://doi.org/10.1007/s11940-015-0349-2