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Pediatric Arterial Ischemic Stroke

Childhood Arterial Ischemic Stroke


Presentation

  • 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]
  • CONCLUSIONS: PAIS occurs more frequently in younger children and this group most frequently presents with convulsion as the initial symptom.[ncbi.nlm.nih.gov]
  • Research suggests that risk factors, outcomes, and presentation are different from those of adult stroke.[ncbi.nlm.nih.gov]
  • Brain regions presenting delayed arterial transit effects were tentatively associated with positive outcome. CONCLUSION: This study demonstrates the clinical utility of ASL in the neuroimaging diagnosis of pediatric AIS.[ncbi.nlm.nih.gov]
  • Ischemic stroke presentation in children may be erroneously attributed to other conditions having similar presentations with which physicians are more familiar.[stroke.ahajournals.org]
Varicella-Zoster Virus Infection
  • virus infection with approximately 14% of children with a a prothrombotic condition and 86% previously healthy. focal cerebral anteriopathy Idiopathic arterial stenosis occurring in the brain providing an inciting region for occlusion. congenital arterial[hawaii.edu]
  • Clinical and radiological features of childhood cerebral infarction following varicella zoster virus infection. Dev Med Child Neurol. 2007 ; 49 : 417–422. Crossref Medline Google Scholar 29 Sebire G, Meyer L, Chabrier S.[ahajournals.org]
  • The results of this case-control study show a significant statistical link between idiopathic arterial ischemic strokes in children and varicella-zoster virus infection.[researchgate.net]
Hunting
  • Hunt , Mark T. Mackay , Paul Monagle , Anne L. Gordon Abstract BACKGROUND: Neuromotor impairments are common after pediatric stroke, but little is known about functional motor outcomes.[pediatrics.aappublications.org]
  • Valantine HA, Hunt SA, Gibbons R, Billingham ME, Stinson EB, Popp RL. Increasing pericardial effusion in cardiac transplant recipients. Circulation 1989 ;79(3):603–609. Crossref, Medline, Google Scholar 44.[pubs.rsna.org]
Plethora
  • The uncommon incidence, age-associated difference and plethora of clinical symptoms make the diagnosis of such strokes extremely difficult and often delayed. The history and clinical examination should point to diseases or predisposing factors.[biomed.papers.upol.cz]
Multiple Organ Dysfunction Syndrome
Death in Childhood
  • Introduction Stroke is among the top 10 causes of death in childhood. 1 Population-based estimates of the annual incidence of childhood stroke range from 4.6 to 13 per 100 000 children. 2 – 4 Traditional adult arterial ischemic stroke (AIS) risk factors[ahajournals.org]
Papilledema
  • (27.3) Aphasia 79 (22.3) Ataxia 71 (20.0) Visual field deficit 46 (13.0) Nonfocal signs Headache 126 (35.5) Decreased level of consciousness 102 (28.7) Nausea/vomiting 85 (23.9) Seizures at presentation 84 (23.7) Vertigo 40 (11.3) Diplopia 12 (3.4) Papilledema[ahajournals.org]
  • Look for signs of increased intracranial pressure, such as papilledema. A full neurologic exam should be completed, including mental status, cranial nerves, motor function, sensory testing, reflexes, and coordination.[now.aapmr.org]

Workup

  • 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]
  • […] 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]
  • The general approach to diagnostic evaluation is summarized in Table III. although in practice the direction of the workup has to be individualized. The evaluation should begin with a computed tomography (CT) scan, without contrast administration.[indianpediatrics.net]

Treatment

  • 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]
  • Intravenous immunoglobulin treatment was given to children with fever and drowsiness. Conclusion : Infection was an important risk factor for children with AIS in China.[tandfonline.com]
  • We sought to determine trends in the use of recombinant tissue plasminogen activator (rt-PA), treatment outcomes, and predictors of mortality for pediatric patients with acute ischemic stroke by using the Nationwide Inpatient Sample.[ncbi.nlm.nih.gov]
  • The risk for new silent lesions and/or stroke was compared for each treatment arm.[researchgate.net]
  • To date there is little evidence on which to base acute treatments for childhood AIS.[annalsofian.org]

Prognosis

  • De Schryver EL, Kappelle LJ, Jennekens-Schinkel A, Peters AC: Prognosis of ischemic stroke in childhood: a long-term follow-up study. Dev Med Child Neurol 2000;42:313–318.[karger.com]
  • 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]
  • Adult patients with space-occupying hemispheric infarctions have a poor prognosis, with an associated fatality rate of 80 %.[researchgate.net]
  • Associated injuries vascular injury nerve injury usually common peroneal nerve injury (25%) tibial nerve injury is less common fractures present in 60% of dislocations soft tissue injuries patellar tendon rupture periarticular avulsion displaced menisci Prognosis[orthobullets.com]
  • Visual prognosis. Patients often ask, “Will my vision get better?” If OCT shows a loss of the nerve fiber layer, the answer is no, Dr. Golnik said. But in other cases, vision may return rapidly.[aao.org]

Etiology

  • 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]
  • 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]
  • Risk factors for neonatal AIS favor inflammatory etiologies, including chorioamnionitis, prolonged rupture of membranes, and other systemic stressors such as hypoglycemia and low APGARs [ 4 ].[pediatricneurologybriefs.com]
  • Because of its multifactorial etiology pediatric AIS probably has a multigenic inheritance pattern.[researchgate.net]
  • ETIOLOGIES/RISK FACTORS Etiologies/risk factors in childhood stroke differ from those in adult stroke 11) .[jkns.or.kr]

Epidemiology

  • 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]
  • Here we review the epidemiology and risk factors for AIS in neonates and children. We also outline consensus-based practices in the evaluation and management of pediatric AIS. Finally we discuss the outcomes observed in this population.[ncbi.nlm.nih.gov]
  • "— Presentation transcript: 1 CEREBRAL VASCULAR ACCIDENTS Pediatric Critical Care Medicine Emory University Children’s Healthcare of Atlanta 2 2 Objectives Epidemiology Risk factors Catergories Treatments 3 3 Epidemiology 2.52/100,000/yr – children thru[slideplayer.com]
  • Epidemiology and classification of perinatal stroke. Semin Fetal Neonatal Med Oct 200914(5): 245–9, DOI: [ PubMed ] Husson, B Hertz-Pannier, L Renaud, C Allard, D Presles, E Landrieu, P et al. AVCnn Group (2010).[pediatricneurologybriefs.com]
  • The implications of this essential difference are stressed in a discussion of how the epidemiology, pathophysiology, diagnosis, and therapeutic advancements in perinatal stroke relate to the outcome of cerebral palsy.[pediatricstroke.org]
Sex distribution
Age distribution

Pathophysiology

  • It is unclear if inflammation is an aspect of the pathophysiology of stroke, or a consequence of tissue injury. [ 1 ] COMMENTARY.[pediatricneurologybriefs.com]
  • This article reviews the unique pathophysiologic entities affecting the pediatric population and the associated MRI findings.[researchgate.net]
  • "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]
  • The implications of this essential difference are stressed in a discussion of how the epidemiology, pathophysiology, diagnosis, and therapeutic advancements in perinatal stroke relate to the outcome of cerebral palsy.[pediatricstroke.org]
  • […] underreported as approximately 50% self-reduce and misdiagnosed demographics 4:1 male to female ratio location tibiofemoral articulation risk factors morbid obesity is a risk factor for "ultra-low energy" knee dislocations with activities of daily living Pathophysiology[orthobullets.com]

Prevention

  • Hospital for Sick Children Health A-Z Search a complete list of child health articles expand_more View All Drug A-Z Search a list of articles about medications expand_more View All Learning Hubs Browse a complete list of content groups Healthy Living & Prevention[aboutkidshealth.ca]
  • Our findings show that in PAIS, SWI provides valuable, time-sensitive, noninvasive information about salvageable brain tissue and may guide early treatment options to prevent infarct progression.[ajnrdigest.org]
  • Variations in RFs by age or geography may inform prioritization of investigations and targeted preventative strategies. Ann Neurol 2011;69:130–140. The full text of this article hosted at iucr.org is unavailable due to technical difficulties.[onlinelibrary.wiley.com]
  • To learn more or modify/prevent the use of cookies, see our Cookie Policy and Privacy Policy.[researchgate.net]
  • Adams RJ, Brambilla D; Optimizing Primary Stroke Prevention in Sickle Cell Anemia (STOP 2) Trial Investigators. Discontinuing prophylactic transfusions used to prevent stroke in sickle cell disease.[annalsofian.org]

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