Stroke in childhood

Yıl 2011, Cilt: 3 Sayı: 2, - , 06.04.2011

Evangelos Pavlou Anastasia Gkampeta

Öz

Stroke in childhood is one of the most common causes of death or severe impairment worldwide, with annual incidence estimated from 1,3 to 13 cases/100.000 population. The definition of stroke consists both of arterial ischemic stroke (AIS) and hemorrhagic stroke. The incidence of ischemic and hemorrhagic stroke in children is approximately the same, in contrast to adults, while the incidence is higher in boys than it is in girls. Risks factors for pediatric stroke differ from those for adults, with arteriopathy and infections being the most commonly risk factors, followed by cardiac diseases. Clinical presentation of stroke in childhood depends on the affected area of the brain, with focal neurological deficit being the most common presentation in older children. The existence of stroke mimics and lack of typical findings in early neuroimaging lead to delay in diagnosis and poor prognosis. The adequate therapy has improved the outcome from pediatric stroke. However, this must be instituted within 3 to 6 hours. Prognosis of pediatric stroke is generally poor, depending on underlying condition. 10% of children who have stroke die, 20% have recurrent stroke and 70% have severe deficits. Our goal should be the rapid diagnosis and therapeutic management, which can contribute to improved outcomes in pediatric stroke.

Anahtar Kelimeler

stroke; ischemia; hemorrhage; children

Kaynakça

• Amelie-Lefond C, Sebire G, Fullerton H. Recent developments in childhood arterial ischemic stroke. Lancet Neurol 2008;7:425-35.
• Mallick AA, O'Callaghan FJ. The epidemiology of childhood stroke. Eur J Paediatr Neurol. 2010;14:197-205.
• Roach ES, Golomb MR, Adams R, Biller J, Daniels S, Deveber G, et al. Management of stroke in infants and children: a scientific statement from a special writing group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke 2008;39:2644-91.
• Raju TN, Nelson KB, Ferriero D, Lynch JK. Ischemic perinatal stroke: summary of a workshop sponsored by the National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke. Pediatrics 2007;120:609-16.
• Earley CJ, Kittner SJ, Feeser BR, Gardner J, Epstein A, Wozniak MA, et al. Stroke in children and sicklecell disease: Baltimore-Washington Cooperative Young Stroke Study. Neurology. 1998;51:169-76.
• Giroud M, Lemesle M, Gouyon JB, Nivelon JL, Milan C, Dumas R, et al. Cerebrovascular disease in children under 16 years of age in the city of Dijon, France: a study of incidence and clinical features from 1985 to 1993. J Clin Epidemiol. 1995;48:1343-8.
• de Veber G, Andrew M, Canadian Pediatric Ischemic Stroke Study Group. Cerebral sinovenous thrombosis in children. N Engl J Med 2001;345:417-23.
• Fullerton HJ, Wu YW, Zhao S, Johnson SC. Risk of stroke in children: ethnic and gender disparities. Neurology 2003;61:189-94.
• Colomb MR, Fullerton HJ, Nowak-Gotl U, De Veber G. Male predominance in childhood ischemic stroke: findings from the international pediatric stroke study. Stroke 2009;40:52-7.
• Kirkham FJ. Is there a genetic basis for pediatric stroke? Curr Opin Pediatr 2003;15:547-58.
• Zimmer JA, Garg BP, Williams LS, Golomb MR. Age related variation presenting signs of childhood arterial ischemic stroke. Pediatr Neurol 2007;37:171-5.
• Jordan LC. Stroke in childhood. The Neurologist 2006;12:94-102.
• Ganesan V, Prengler M, McShane MA, Wade AM, Kirkham FJ. Investigation of risk factors in children with arterial ischemic stroke. Ann Neurol 2003;53:167-73.
• Kirton A, de Veber G. Therapeutic approaches and advances in pediatric stroke. Journal of the American Society for Experimental NeuroTherapeutics 2006;3:133-42.
• Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke 2007; 38:1655-711.
• Mallouh AA, Hamdam JA. Intracranial hemorrhage in patients with sickle cell disease. Am J Dis Child 1986;140:505-6.
• Prengler M, Pavlakis SG, Prohovnik I, Adams RJ. Sickle cell disease: the neurological complications. Ann Neurol 2002;51:543-52.
• Filippidis A, Kapsalaki E, Patramani G, Fountas KN. Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis, and treatment. Neurosurg Focus. 2009;27:E3.
• Eleftheriou D, Ganesan V. Controversies in childhood arterial ischemic stroke and cerebral venous sinus thrombosis. Expert Rev Cardiovasc Ther. 2009;7:853-61.
• Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F; ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 2004; 35:664-70.
• Shellhaas RA, Smith SE, O'Tool E, Licht DJ, Ichord RN. Mimics of childhood stroke: characteristics of a prospective cohort. Pediatrics 2006;118:704-9.
• Pavlakis SG, Phillips PC, DiMauro S, De Vivo DC, Rowland LP. Mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes: a distinctive clinical syndrome. Ann Neurol 1984; 16:481-8.
• Rafay MF, Pontigon AM, Chiang J, Adams M, Jarvis DA, Silver F, et al. Delay to diagnosis in acute pedriatic arterial stroke. Stroke. 2009;40:58-64.
• Ganesan V. Clinical guidelines for the management of childhood stroke. Hosp Med. 2005;66:4-6.
• Roach ES, Golomb MR, Adams R, Biller J, Daniels S, Deveber G, et al. Management of stroke in infants and children: a scientific statement from a special writing group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the young. Stroke 2008;39:2644-91.
• Monagle P, Chalmers E, Chan A, DeVeber G, Kirkham F, Massicotte P, et al. Antithrombotic therapy in neonates and children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 2008;133:887-968.
• Mohr JP, Thompson JL, Lazar RM, Levin B, Sacco RL, Furie KL, et al. A comparison of warfarin and aspirin for the prevention or recurrent ischemic stroke. N Engl J Med 2001;345:1444-51.
• Scott RM, Smith ER. Moyamoya disease and Moyamoya syndrome. N Engl J Med 2009;360:1226-37.
• Kim SK, Seol HJ, Cho BK, Hwang YS, Lee DS, Wang KC. Moyamoya disease among young patients: its aggressive clinical course and the role of active surgical treatment. Neurosurgery 2004; 54:840-4.
• Jordan LC, Hills AE. Hemorrhagic stroke in children. Pediatr Neurol 2007;36:73-80.
• Delsing BJ, Catsman-Berrevoets CE, Appel IM. Early prognostic indicators of outcome in ischemic childhood stroke. Pediatr Neurol. 2001;24:283-9.
• Ganesan V, Hogan A, Shack N, Gordon A, Isaacs E, Kirkham FJ. Outcome after ischaemic stroke in childhood. Dev Med Child Neurol 2000; 42:455-61.
• Fullerton HJ, Wu YW, Sidney S, Johnston SC. Risk of recurrent childhood arterial ischemic stroke in a population-based cohort: the importance of cerebrovascular imaging. Pediatrics 2007;119:495-501.
• deVeber GA, MacGregor D, Curtis R, Mayank S. Neurologic outcome in survivors of childhood arterial ischemic stroke and sinovenous thrombosis. J Child Neurol 2000; 15:316-24.