Hemi-anopsia was the presenting symptom in 4 (57%) of the 7 patients with occipital stroke. Table 2. [ahajournals.org]

Several predictors of the delayed AIS diagnosis were identified in the present study. Efforts to target these predictors can reduce diagnostic delays and optimize the management of AIS in children. [ncbi.nlm.nih.gov]

Most of the patients presented with motor involvement (79%) and seizures (45%). Patients presented less frequently with consciousness impairment (15%) and headache (10%). [journals.sagepub.com]

No identifiable RFs was present in 54 (9%). [onlinelibrary.wiley.com]

• Anemia

  For all 42 cases, the most frequent etiologies were infections (38.1%, n = 16), iron deficiency anemia (16.7%, n = 7), and moyamoya syndrome (11.9%, n = 5). [ncbi.nlm.nih.gov]

  Sickle cell anemia may cause cerebral ischemia linked with the irregularly shaped blood cells. Sickle shaped blood cells clot more easily than normal blood cells, obstructing blood flow to the brain. [columbianeurosurgery.org]

  –Hemolytic anemias: thalassemia, hereditary spherocytosis & paroxysmal nocturnal hemoglobinuria Metabolic disorders –Homocysteinemia: predispose to vessel abn. [slideplayer.com]

• Epilepsy

  Medical records were reviewed for timing, semiology, and treatment of acute symptomatic seizures, remote symptomatic seizures (RSS), and epilepsy. Cumulative incidence of RSS and epilepsy were assessed using survival analysis. [ncbi.nlm.nih.gov]

  Pediatric arterial ischemic stroke (AIS) is an uncommon but important cause of neurologic morbidity in neonates and children, with consequences including hemiparesis, intellectual disabilities, and epilepsy. [jhu.pure.elsevier.com]

  2 years poststroke - Describe seizure control in patients who developed epilepsy after experiencing pediatric AIS - Discuss predictors of subsequent remote symptomatic seizures and epilepsy in patients with childhood arterial ischemic stroke (CAIS) [opencme.org]

• Asymptomatic

  Only two complications were noted: asymptomatic intracerebral hemorrhage and mucosal bleeding. Five patients developed malignant middle cerebral artery infarctions. [reliasmedia.com]

  It is likely that the total incidence of perinatal stroke is much higher than these quoted statistics since some children who are asymptomatic in the newborn period are later identified as having a presumed neonatal stroke by imaging when they present [pediatricneurologybriefs.com]

  A clinical follow-up of the original asymptomatic sickle cell patients with positive TCD, MRA, and MRI was also made. [researchgate.net]

  Asymptomatic multinodular bluish or brownish erythematous plate, developing over years, with its typical ‘protuberant' aspect, is the most frequently observed clinical aspect [1,6]. [karger.com]

  Neuroimaging fails to identify asymptomatic carriers of familial porencephaly. Belgium. October 2002 Hand function in children with hemiplegic cerebral palsy : prospective follow-up and functional outcome in adolescence. Italy. Feb. 2003 [chasa.org]

• Impaired Balance

  partial or complete blindness, diplopia, blurred vision Incoordination and impaired balance Horner's syndrome (may signify carotid dissection or brainstem stroke) Severe headache Nausea and/or vomiting Back to Top Differential Diagnosis: Structural [educatehealth.ca]

• Hypotension

  Hypertension or postural hypotension may have been a precipitating factor. Hypotension may occur because of shock (circulatory collapse). Increased ICP may occur because of tissue edema or clot formation. [nurseslabs.com]

  –Clinical condition: HTN encephalopathy, eclampsia, AC in SCD, immunosuppression –Acute hypotension (poor cardiac fxn/anemia) –Rapid resolution: vasogenic cerebral edema prob secondary to autoregulation & endothelial injury Acute Disseminated Encephalomyelitis [slideplayer.com]

  Other causes Any factor that impairs systemic perfusion (eg, carbon monoxide toxicity, severe anemia or hypoxia, polycythemia, hypotension) increases risk of all types of ischemic strokes. [merckmanuals.com]

  Other childhood cerebrovascular disorders that were excluded included transient ischemic attack without infarction, hypotensive watershed injury, reversible hypertensive leukoen-cephalopathy, diffuse hypoxic encephalopathies, and asymptomatic infarction [jkns.or.kr]

  Decreased perfusion of the brain occurs when blood flow to it is partially or completely restricted (e.g., compression of arterial flow in near-hanging or near-strangulation), when blood pressure is very low (e.g., hypotensive or hemorrhagic shock), or [internationalbrain.org]

• Hemianopsia

  Vascular territory Symptoms Internal carotid artery Hemiparesis, aphasia, and hemianopsia Anterior cerebral artery Hemiparesis, especially leg Middle cerebral artery Arm hemiparesis, hemianopsia, and aphasia Posterior cerebral artery Hemianopsia, ataxia [hindawi.com]

  Difficulty speaking – This includes problems generating speech (expressive dysphasia), understanding speech (receptive dysphasia), or decreased clarity of speech (dysarthria) Vision abnormalities – Includes loss of vision on one side (hemianopsia) or [childneurologyfoundation.org]

  In general, the presence of hemiparesis, disphasia/aphasia (not limited to stroke of the dominant side in childhood, because of immature lateralization of language), and hemianopsia suggests a suvratentorial cerebral territory involvement, while ataxia [link.springer.com]

• Seizure

  Younger children were more likely to present with seizures at stroke ictus, and acute symptomatic seizures were predictive of later RSS and epilepsy in CAIS. [ncbi.nlm.nih.gov]

  Furthermore, presentation without seizures and Hispanic ethnicity were also associated with mortality for neonates and children, respectively. [mdedge.com]

  Additional risk factors associated with in-hospital mortality in neonates and children with AIS include the absence of seizures on presentation and Hispanic ethnicity, respectively. [neurologyadvisor.com]

• Dysarthria

  Normal articulation 0 Mild to moderate dysarthria 1 Severe dysarthria (unintelligible or worse) 2 Untestable — Neglect No neglect 0 Partial neglect 1 Complete neglect 2 *Total score is the sum of the scores for individual items. † Patients are asked [merckmanuals.com]

  Diplopia Double vision Dysarthria Unclear or slurred speech Dysphasia Speech difficulty. May be trouble making speech (expressive dysphasia) or understanding speech (receptive dysphasia). [childneurologyfoundation.org]

  CASE An 11-year-old Hispanic male presented to the ED 30 minutes after the sudden onset of headache, left-sided weakness and dysarthria. His vital signs were within normal limits. Left arm and leg strength were 2/5 with a noticeable facial droop. [westjem.com]

  Additional common focal neurologic deficits are diplopia, dysarthria, vertigo and ataxia. Seizures at the onset of stroke are common both in ischemic and hemorrhagic stroke, compared to adult. [jkns.or.kr]

  Mixed or other 19 (5.4) Country United States 223 (62.8) Canada 60 (16.9) Australia 16 (4.5) Philippines 16 (4.5) Chile 14 (3.9) United Kingdom 11 (3.1) France 6 (1.7) Serbia 5 (1.4) China 4 (1.1) Stroke presentation Focal signs Hemiparesis 285 (80.3) Dysarthria [ahajournals.org]

• Neglect

  No neglect 0 Partial neglect 1 Complete neglect 2 *Total score is the sum of the scores for individual items. † Patients are asked their age and the current month. ‡ Patients are asked to open and close the eyes and to make a fist. [merckmanuals.com]

  Neglected tumours may reach large proportions. More examples of dermatofibrosarcoma protuberans How is dermatofibrosarcoma protuberans diagnosed? The absence of symptoms often leads to a delay in diagnosis of d ermatofibrosarcoma protuberans. [dermnetnz.org]

  Consequently, patients frequently tend to neglect their problem and presentation can be late. Most patients have this tumor either as a stable lesion or growing over years. [ncbi.nlm.nih.gov]

  Not surprisingly, this tumor's indolent behavior was often the cause for initial neglect. Therefore, in many cases, treatment was sought only after the onset of symptoms. [acsjournals.onlinelibrary.wiley.com]

  […] sitting, pulling to stand, crawling, and walking Hemiplegic cerebral palsy Signs/symptoms in children older than 1 year: Recurrent focal seizures: >50% cases may present in this fashion Sudden onset of any of the following: Hemi-body paresis or paralysis Neglect [educatehealth.ca]

• Apathy

  Behavior – May experience agitation, irritability, mood swings, hyperactivity, apathy and emotional and behavioral outbursts as a result of the brain injury. The psychosocial problems can be extremely complex. [chasa.org]

  Clinical features include apathy or restlessness, seizures or tremors, high-pitched cry, and irregular respirations(32). [indianpediatrics.net]

  Selected Stroke Syndromes Symptoms and Signs Syndrome Contralateral hemiparesis (maximal in the leg), urinary incontinence, apathy, confusion, poor judgment, mutism, grasp reflex, gait apraxia Anterior cerebral artery (uncommon) Contralateral hemiparesis [merckmanuals.com]

• Agitation

  Behavior – May experience agitation, irritability, mood swings, hyperactivity, apathy and emotional and behavioral outbursts as a result of the brain injury. The psychosocial problems can be extremely complex. [chasa.org]

  Transthoracic echocardiogram with agitated saline (producing bubble artifact) is a specific test that has been used to assess for a patent foramen ovale. The release of venous thrombi can exploit this bypass to deposit in the cerebral vasculature. [hawaii.edu]

  Echocardiography can be used to identify shunting via a bubble study, in which agitated saline is injected intravenously and in the presence of shunting will appear more rapidly in the left ventricle than in patients without shunts. [pubs.rsna.org]

Volpe warned that as soon as the case seems to be progressing, involves pain, or is associated with atypical disc findings, a more detailed workup is indicated, including an MRI scan and blood workup for systemic inflammation and multiple sclerosis. [aao.org]

After transfer to a children’s hospital and an exhaustive workup, the etiology of his stroke remained unclear. At four-month outpatient follow-up, the patient had only minimal left arm weakness. [westjem.com]

MR imaging is not routinely performed as part of the workup of patients with these neoplasms because of their typical clinical appearance and superficial location. [ajronline.org]

[…] amputation or explanation needed Limb Ataxia 0-2: absent to present in 2 limbs Sensory 0-2: normal to severe/total sensory loss Best Language 0-3: no aphasia to mute/global aphasia Labs and Imaging Imaging is of critical importance in the diagnostic workup [hawaii.edu]

Cardiac workup of ischemic stroke: can we improve our diagnostic yield?Stroke. 2009; 40:2893–2898. doi: 10.1161/STROKEAHA.109.551226LinkGoogle Scholar 28. [ahajournals.org]

In their cohort, at most, four children per year underwent recanalization treatment. [reliasmedia.com]

61 Slavova N...Grunt S 30722076 2019 6 Hemorrhagic Transformation of Arterial Ischemic and Venous Stroke in Children. 61 Hutchinson ML...Beslow LA 30904397 2019 7 Mechanical thrombectomy using a Solitaire stent retriever in the treatment of pediatric [malacards.org]

Definitive evidence-based treatment for pediatric stroke awaits the development of randomized controlled trials. [journals.lww.com]

Judicious extrapolation of adult data might be used for treatment of these cases with a highly individualized approach at high-volume centers, by a neurointerventional team in close collaboration with pediatric stroke neurologists. [content.iospress.com]

(minutes) Acute management of stroke: [ Time Frame: 1 day ] Median door-to-needle delay (minutes) Secondary Outcome Measures : Treatment-emergent adverse events: [ Time Frame: 7 days ] Intracranial hemorrhage (yes/no) Treatment-emergent adverse events [clinicaltrials.gov]

Prognosis The prognosis is excellent for low grade lesions but a poorer prognosis is associated with the FS variant due to a higher risk of recurrence and metastases. Overall, the rate of mortality is low (< 3% at 10 years). [orpha.net]

MRI T1: low signal T2 high signal usually higher than or equal to adjacent subcutaneous fat fat saturation sequences: suppressed T1 C+ (Gd): enhances Treatment and prognosis Dermatofibrosarcoma protuberans has an excellent prognosis after complete resection [radiopaedia.org]

Natural history, prognosis and lipid abnormalities of idiopathic ischemic childhood stroke. J Child Neurol. 1996; 11:276-282 Hemorrhagic stroke have higher mortality rates as compared to ischemic stroke. [slideshare.net]

The general prognosis for DFSP is excellent. [sarcomahelp.org]

prognosis as excellent; DFSP are also reported to have a high recurrence rate. [ncbi.nlm.nih.gov]

This study aimed to determine the etiology, clinical presentation, and radiologic features of neurological deficit for pediatric arterial ischemic stroke (PAIS). [ncbi.nlm.nih.gov]

ETIOLOGIES/RISK FACTORS Etiologies/risk factors in childhood stroke differ from those in adult stroke 11). [jkns.or.kr]

The American Heart Association guidelines on infant and pediatric stroke give recommendations based on etiology. Treatment options include intravenous thrombolysis (IVT), intra-arterial thrombolysis (IAT), and mechanical thrombectomy. [reliasmedia.com]

Pediatric arterial ischemic stroke: Epidemiology, risk factors, and management. [jhu.pure.elsevier.com]

This review examines the epidemiology and etiologies of neonatal and childhood AIS and provides a detailed discussion of approaches to the clinical characterization, diagnostic evaluation, and management. [ncbi.nlm.nih.gov]

This review examines the epidemiology and etiologies of neonatal and childhood AIS and provides a detailed discussion of approaches to the clinical… CONTINUE READING [pdfs.semanticscholar.org]

After an opening section on basics such as pathophysiology, radiological assessment, and pathology, comprehensive and up-to-date information is provided on each of the available therapies, techniques, and practices. [books.google.com]

It is unclear if inflammation is an aspect of the pathophysiology of stroke, or a consequence of tissue injury. [ 1 ] COMMENTARY. [pediatricneurologybriefs.com]

Additional complicating factors include typically increased delays and increased challenge to appropriate diagnosis in children relative to adults, and underlying differences in the pathophysiology of AIS, the thrombotic cascade, and the natural history [content.iospress.com]

"Hypoxic-ischemic brain injury: pathophysiology, neuropathology and mechanisms." NeuroRehabilitation 26 (1): 5-13. Calvert, J. W. and J. H. Zhang (2005). "Pathophysiology of an hypoxic-ischemic insult during the perinatal period." [internationalbrain.org]

This article reviews the unique pathophysiologic entities affecting the pediatric population and the associated MRI findings. [researchgate.net]

“With the consequences of childhood stroke so often devastating and lifelong, it is critical to find out as much as we can about it and develop strategies to prevent it, recognize it when it occurs and prevent further recurrence,” says Dr. Friedman. [consultqd.clevelandclinic.org]

The results of the current study could be used for planning more preventive strategies in patients suffering from the mentioned diseases. [ijpvmjournal.net]

Arterial ischemic stroke in children represents a significant disorder with a concerning high rate of adverse outcomes, including potentially preventable recurrent stroke. [journals.lww.com]

[…] of Cardiovascular Disease 2017 1.24 MB 2017 Management of Dyslipidaemia 2017 (5th Edition) 1.12 MB 2017 Prevention, Diagnosis and Management of Infective Endocarditis 2017 5.10 MB 2016 Heart Disease in Pregnancy (2nd Edition) 16.6 MB 2016 Prevention [acadmed.org.my]

Antifibrinolytics : aminocaproic acid (Amicar); Used with caution in hemorrhagic disorder to prevent lysis of formed clots and subsequent rebleeding. [nurseslabs.com]