Stroke in children and adolescents: topical problems of pre-hospital diagnostics

The article is devoted to the urgent problem of pediatrics and pediatric neurology, pre-hospital diagnosis of stroke in children. A review of domestic and foreign literature on the early diagnosis of stroke in children and adolescents, as well as epidemiological data on pediatric stroke, is presented. Particular attention is paid to the features of the symptoms of stroke and stroke-like conditions («stroke masks») in the pediatric population and the analysis of the main factors that influence errors in the early diagnosis of stroke in children and adolescents. Currently, in the diagnosis of ischemic stroke, its «masks» are found in 53.9 % of cases, with hemorrhagic stroke, in 36.3 %, and with transient ischemic attacks, in 9.8 % of cases. One of the most common diseases with which it is necessary to differentiate ischemic stroke in children is migraine. This problem is covered in academic writings that highlight the leading differential diagnostic criteria for migraine and stroke, and also represent a diagnostic algorithm. The clinical features of pediatric stroke, especially manifest symptoms, make it difficult to apply adult screening stroke scales in pediatrics. The article discusses the main scales for the early diagnosis of stroke in adults, and their potential application in pediatric practice. Currently accumulated experience in prehospital and early diagnosis of stroke in children determines the main directions of work to reduce the time of diagnosis of acute cerebrovascular accidents in children, followed by the introduction of reperfusion therapy in pediatric practice.

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Characteristics of Pediatric Stroke and Association of Delayed Diagnosis with Mortality in a Mexican Tertiary Care Hospital

Neuropediatrics ◽

10.1055/s-0041-1731802 ◽

2021 ◽

Author(s):

Gerardo Garza-Alatorre ◽

Ana Luisa Carrion-Garcia ◽

Alfredo Falcon-Delgado ◽

Elda Carolina Garza-Davila ◽

Angel R Martinez-Ponce de Leon ◽

...

Keyword(s):

Ischemic Stroke ◽

Hemorrhagic Stroke ◽

Early Recognition ◽

Tertiary Care ◽

Delayed Diagnosis ◽

University Hospital ◽

Pediatric Stroke ◽

Care Hospital ◽

Continuous Increase ◽

Common Risk Factors

Abstract Background and objectives Pediatric cerebrovascular disease carries significant morbidity and mortality. Early recognition of a pediatric stroke as well and its most common risk factors are important, but that diagnosis is often delayed. It is believed that the incidence in our center is higher than it appears. This study aims to assess the incidence and characteristics of the pediatric stroke in our university hospital. Likewise, this study seeks to evaluate if a longer symptoms-to-diagnosis time is associated with mortality in patients with ischemic stroke. Methods A retrospective study including children with stroke admitted to the UANL University Hospital from January 2013 to December 2016. Results A total of 41 patients and 46 stroke episodes were admitted. About 45.7% had an ischemic stroke and 54.3% had a hemorrhagic stroke. A mortality of 24.4% and a morbidity of 60.9% were recorded. Regarding ischemic and hemorrhagic stroke, an increased symptoms-to-diagnosis time and a higher mortality were obtained with a relative risk of 2.667 (95% confidence interval [CI]: 1.09–6.524, p = 0.013) and 8.0 (95% CI: 2.18–29.24, p = < 0.0001), respectively. A continuous increase in the incidence rate, ranging from 4.57 to 13.21 per 1,000 admissions comparing the first period (2013) versus the last period (2016), p = 0.02, was found in our center. Conclusions Pediatric stroke is a rare disease; however, its incidence shows a continuous increase. More awareness toward pediatric stroke is needed.

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Abstract WMP111: Socioeconomic Determinants of Outcome After Childhood Arterial Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.wmp111 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Lori C Jordan ◽

Nancy K Hills ◽

Warren Lo ◽

Rebecca N Ichord ◽

Christine K Fox ◽

...

Keyword(s):

Ischemic Stroke ◽

Maternal Education ◽

Recurrent Stroke ◽

Pediatric Population ◽

Neurological Deficits ◽

Pediatric Stroke ◽

Arterial Ischemic Stroke ◽

Vascular Effects ◽

Middle Income ◽

Poor Outcome

Introduction: Lower socioeconomic status (SES) is associated with poorer outcome after adult stroke. In a large cohort of children with arterial ischemic stroke (AIS), we determined 12-month neurological outcome and tested the hypothesis that SES is a determinant of outcome in children. Methods: From 2009-2014, the Vascular Effects of Infection in Pediatric Stroke (VIPS) study enrolled 355 children with AIS (29 days-18 years) at 37 international centers, including 3 in lower and middle income (LAMI) countries. Outcome was assessed at 12 months via the recurrence and recovery questionnaire (RRQ) parental report of the pediatric stroke outcome measure (PSOM). Poor outcome was defined as a PSOM of ≥1. Results: Of 355 children, outcome was available for 310 (87%) at a median of 12 months (IQR 11-13). Ten children died prior to hospital discharge and 4 by 12 months. Outcomes improved from discharge to 12 months (Figure). Of 23 cases in LAMI countries, 88% had an income <USD$10,000, compared to 11% of 287 cases in non-LAMI countries. Overall, only 39% LAMI cases had a good outcome, versus 61% of non-LAMI cases (p=0.052). There were too few cases to analyze outcome predictors in LAMI countries. However, in non-LAMI countries, income did not independently predict poor outcome (OR 1.7, 95% CI 0.57, 4.8, for income <$10,000 vs. >$100,000). Other markers of SES (maternal education level and rural/suburban/urban residence) also did not predict outcome. Independent predictors of poor outcome included moderate (OR 4.6, 95% CI 2.0, 11) or severe (OR 21, 95% CI 7.1, 60) neurological deficits at discharge (compared to no deficits) and recurrent stroke (OR 3.5, 95% CI 1.5, 8.3). Conclusion: Outcomes after childhood stroke may be worse in LAMI countries, although we were underpowered to study this subgroup. Within non-LAMI countries, SES does not appear to impact outcome in children, unlike reports in adults, perhaps reflecting better access to rehabilitation services in the pediatric population.

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Abstract P84: Covid-19 and Stroke in the Latin American Stroke Registry (LASE)

Stroke ◽

10.1161/str.52.suppl_1.p84 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Virginia Pujol-Lereis ◽

Alan F Flores ◽

Antonio Arauz ◽

Carlos Abanto ◽

Pablo Amaya ◽

...

Keyword(s):

Latin America ◽

Ischemic Stroke ◽

Latin American ◽

Clinical Characteristics ◽

Hemorrhagic Stroke ◽

Reperfusion Therapy ◽

Infection Frequency ◽

Stroke Patients ◽

Vessel Occlusion ◽

Stroke Registry

Background: Ischemic stroke has been reported to occur in approximately 5% of COVID-19 patients, although some reports are contradictory. Proposed mechanisms of this association are hypercoagulable state, vasculitis and cardiomyopathy, together with traditional vascular risk factors. We analyzed the frequency and clinical characteristics of COVID-19 positive stroke cases during the first months of the pandemic in Latin America. Methods: A multinational study (7 countries, 18 centers) of patients admitted during the pandemic outbreak (March - June 2020). We assessed acute stroke cases associated to COVID-19 infection. Clinical characteristics, stroke etiology and severity, acute care and functional outcomes, were compared between non-COVID-19 and COVID-19 cases. Results: There were a total of 1037 stroke cases; sixty-two of them (6.0%) were diagnosed with COVID-19 infection. This group consisted of 38 men [61.3%], with a median age of 68 years [IQR 59-79 years]. From these cases, 80.6% were ischemic stroke, 16.1% hemorrhagic stroke, and 1.6% transient ischemic attack and cerebral venous thrombosis respectively. The most common etiology reported for ischemic cases was atherosclerotic large vessel occlusion (30.6% vs. 12.7% in non-COVID cases, p<0.001), and undetermined etiology for hemorrhagic stroke (55.6%). Median NIHSS for COVID-stroke patients was higher (7 IQR 2-16 vs. 5 IQR 2-11, p=0.05). Five (8.1%) patients received acute reperfusion therapy, with no differences in door-to-CT, door-to-needle and door-to-groin times, compared to non-COVID cases. Most characteristics did not differ from those of COVID-19 negative patients. Mortality was higher in COVID-stroke cases (20.9% vs. 9.6%, p<0.001). Conclusions: COVID-19 infection frequency in stroke patients in Latin America is similar to that reported in several series worldwide, with a higher frequency of atherosclerotic ischemic strokes and mortality compared to non COVID-19 strokes

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Pediatric Stroke: Clinical Findings and Radiological Approach

Stroke Research and Treatment ◽

10.4061/2011/172168 ◽

2011 ◽

Vol 2011 ◽

pp. 1-11 ◽

Cited By ~ 7

Author(s):

Giuseppe Lanni ◽

Alessia Catalucci ◽

Laura Conti ◽

Alessandra Di Sibio ◽

Amalia Paonessa ◽

...

Keyword(s):

Ischemic Stroke ◽

Magnetic Resonance ◽

Hemorrhagic Stroke ◽

Clinical Findings ◽

Pediatric Stroke ◽

Arterial Ischemic Stroke ◽

Venous Circulation ◽

Cerebral Sinovenous Thrombosis ◽

First Choice ◽

Sinovenous Thrombosis

This paper focuses on radiological approach in pediatric stroke including both ischemic stroke (Arterial Ischemic Stroke and Cerebral Sinovenous Thrombosis) and hemorrhagic stroke. Etiopathology and main clinical findings are examined as well. Magnetic Resonance Imaging could be considered as the first-choice diagnostic exam, offering a complete diagnostic set of information both in the discrimination between ischemic/hemorrhagic stroke and in the identification of underlying causes. In addition, Magnetic Resonance vascular techniques supply further information about cerebral arterial and venous circulation. Computed Tomography, for its limits and radiation exposure, should be used only when Magnetic Resonance is not available and on unstable patients.

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P.070 Thrombolysis without large vessel occlusion in a child with acute arterial ischemic stroke

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2019.170 ◽

2019 ◽

Vol 46 (s1) ◽

pp. S33

Author(s):

IE Hanes ◽

SL Orr ◽

J Davila ◽

A Kirton ◽

E Sell

Keyword(s):

Ischemic Stroke ◽

Case Reports ◽

Pediatric Population ◽

Large Vessel ◽

Pediatric Stroke ◽

Large Vessel Occlusion ◽

Arterial Ischemic Stroke ◽

Vessel Occlusion ◽

Intravenous Tissue Plasminogen Activator ◽

Iv Tpa

Background: Stroke is a rare neurological disease in children, with an annual incidence of 2 - 13/100,000 children per year. Pediatric stroke is associated with significant morbidity and mortality lasting many decades. Diagnosis of pediatric stroke is challenging and often delayed, limiting options for acute intervention, and the pharmacological and mechanical recanalization strategies that have revolutionized adult stroke remain undefined in children. Clinicians are left to draw conclusions from other retrospective cohort studies or case reports and extrapolate adult guidelines to the pediatric population. The TIPS trial eligibility criteria are often used in clinical practice, despite not being validated for this purpose. We present here the case of a healthy 14 year old male who was treated with intravenous tissue plasminogen activator (IV tPA) for a presumed arterial ischemic stroke without large vessel occlusion on neuroimaging. Methods: Retrospective chart review Results: Not applicable Conclusions: Following the administration of IV tPA, the patient made a full recovery. While we do not recommend the routine use of IV tPA for treatment of presumed large vessel or small vessel in children, we suggest that the decision to proceed with IV tPA be considered on a case-by-case basis.

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Modern aspects of hepatology: liver steatosis and fibrosis through the prism of comorbidity in pediatric practice

ScienceRise Medical Science ◽

10.15587/2519-4798.2021.232478 ◽

2021 ◽

pp. 50-55

Author(s):

Larysa Strashok ◽

Svetlana Turchyna ◽

Natalia Shevchenko ◽

Zalina Yeloyeva ◽

Olga Belousova ◽

...

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Children And Adolescents ◽

Hepatic Steatosis ◽

Fatty Liver Disease ◽

Pediatric Population ◽

Pediatric Practice ◽

Adequate Treatment ◽

Alcoholic Fatty Liver ◽

Alcoholic Fatty Liver Disease

The relevance of the topic is dictated by the growing prevalence of hepatic steatosis and fibrosis in the pediatric population, which is due to an increase in the number of pathologies of various organs and systems, which may be accompanied by the development of these liver lesions. The aim of the study: to analyze the data of modern sources of scientific literature regarding the prevalence and features of the course of pathology of various organs and systems, which is associated with the development of steatosis and liver fibrosis in the pediatric population. Materials and methods. A systematic search of scientific was carried out using Web of Science, Scopus, PubMed, scientific bases with key words: «hepatic steatosis», «hepatic fibrosis», «non-alcoholic fatty liver disease», «comorbid pathology», «children and adolescents». Conclusions. Currently, the number of children and adolescents who are diagnosed with steatosis and/or fibrosis of the liver is increasing in the world. In particular, the formation of this pathology is associated with the presence of metabolic syndrome and is associated with its main components, such as obesity, hypertension, disorders of carbohydrate and lipid metabolism. More and more studies indicate the role of non-alcoholic fatty liver disease, which is based on steatosis, as a comorbid pathology in systemic, cardiovascular, endocrine diseases, gastrointestinal tract pathology, and genetic disorders. Also, a number of drugs with steatogenic and fibrogenic effects on liver tissue have been established, which are widely used in pediatric practice. It is necessary to monitor the structural and functional state of the liver already in childhood and adolescence for adequate treatment of the underlying disease and prevention of the formation of comorbid pathology

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Reasons in favour of universal vaccination campaign against COVID-19 in the pediatric population

Italian Journal of Pediatrics ◽

10.1186/s13052-021-01192-4 ◽

2022 ◽

Vol 48 (1) ◽

Author(s):

Nicola Principi ◽

Susanna Esposito

Keyword(s):

Children And Adolescents ◽

Mental Health Problems ◽

Pediatric Population ◽

Vaccination Campaign ◽

Pediatric Intensive Care ◽

Epidemiological Data ◽

The Elderly ◽

School Closure ◽

Prophylactic Measures ◽

Vaccines For Children

Abstract Background Despite the growing evidence of the extreme efficacy of COVID-19 vaccines in adults and the elderly, the administration of the same prophylactic measures to pediatric subjects is debated by some parents and by a number of researchers. The aim of this manuscript is to explain the reasons for overcoming hesitancy towards COVID-19 vaccination in children and adolescents and to highlight the importance of universal COVID-19 vaccination in the pediatric population. Main findings Recent epidemiological data suggest that the risk that a child with COVID-19 is hospitalized or admitted to the pediatric intensive care unit is greater than initially thought. Children may also suffer from long COVID and school closure because of COVID-19 can cause relevant mental health problems in the pediatric population. Placebo-controlled, observer-blinded, clinical trials showed appropriate efficacy, safety and tolerability of authorized mRNA COVID-19 vaccines in children and adolescents 12–17 years old. Vaccination in children younger than 12 years of age will allow further benefits . Conclusions COVID-19 vaccine administration seems mandatory in all the children and adolescents because of COVID-19 related complications as well as the efficacy, safety and tolerability of COVID-19 vaccines in this population. Due to the recent approval of COVID-9 vaccines for children 5–10 years old, it is desirable that vaccine opponents can understand how important is the universal immunization against COVID-19 for the pediatric subjects.

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