scholarly journals Pediatric Stroke: Clinical Findings and Radiological Approach

2011 ◽  
Vol 2011 ◽  
pp. 1-11 ◽  
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.

Pediatric Hyperacute Arterial Ischemic Stroke Pathways at Canadian Tertiary Care Hospitals

2021 ◽  
pp. 1-8
Author(s):  
Maria Gladkikh ◽  
Hugh J. McMillan ◽  
Andrea Andrade ◽  
Cyrus Boelman ◽  
Ishvinder Bhathal ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Tertiary Care ◽  
Pediatric Stroke ◽  
Arterial Ischemic Stroke ◽  
Pediatric Hospitals ◽  
First Choice ◽  
Similarities And Differences ◽  
Pre Treatment ◽  
Magnetic Resonance Imaging Mri ◽  
Iv Tpa

ABSTRACT: Background: Childhood acute arterial ischemic stroke (AIS) is diagnosed at a median of 23 hours post-symptom onset, delaying treatment. Pediatric stroke pathways can expedite diagnosis. Our goal was to understand the similarities and differences between Canadian pediatric stroke protocols with the aim of optimizing AIS management. Methods: We contacted neurologists at all 16 Canadian pediatric hospitals regarding AIS management. Established protocols were analyzed for similarities and differences in eight domains. Results: Response rate was 100%. Seven (44%) centers have an established AIS protocol and two (13%) have a protocol under development. Seven centers do not have a protocol; two redirect patients to adult neurology, five rely on a case-by-case approach for management. Analysis of the seven protocols revealed differences in: 1) IV-tPA dosage: age-dependent 0.75–0.9 mg/kg (N = 1) versus age-independent 0.9 mg/kg (N = 6), with maximum doses of 75 mg (N = 1) or 90 mg (N = 6); 2) IV-tPA lower age cut-off: 2 years (N = 5) versus 3 or 10 years (each N = 1); 3) IV-tPA exclusion criteria: PedNIHSS score <4 (N = 3), <5 (N = 1), <6 (N = 3); 4) first choice of pre-treatment neuroimaging: computed tomography (CT) (N = 3), magnetic resonance imaging (MRI) (N = 2) or either (N = 2); 5) intra-arterial tPA use (N = 3) and; 6) mechanical thrombectomy timeframe: <6 hour (N = 3), <24 hour (N = 2), unspecified (N = 2). Conclusions: Although 44% of Canadian pediatric hospitals have established AIS management pathways, several differences remain among centers. Some criteria (dosage, imaging) reflect adult AIS literature. Canadian expert consensus regarding IV-tPA and endovascular treatment should be established to standardize and implement AIS protocols across Canada.

scholarly journals Swallowing, Oral Motor, Motor Speech, and Language Impairments Following Acute Pediatric Ischemic Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Victoria Sherman ◽  
Rosemary Martino ◽  
Ishvinder Bhathal ◽  
MN, Gabrielle DeVeber ◽  
Nomazulu Dlamini ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Caregiver Burden ◽  
Language Impairment ◽  
Pediatric Stroke ◽  
Speech And Language ◽  
Motor Speech ◽  
Oral Motor ◽  
Cerebral Sinovenous Thrombosis ◽  
Speech And Language Impairment ◽  
Sinovenous Thrombosis

Background and Purpose: Following adult stroke, dysphagia, dysarthria, and aphasia are common sequelae. Little is known about these impairments in pediatric stroke. We assessed frequencies, co-occurrence and associations of dysphagia, oral motor, motor speech, language impairment, and caregiver burden in pediatric stroke. Methods: Consecutive acute patients from term birth-18 years, hospitalized for arterial ischemic stroke (AIS), and cerebral sinovenous thrombosis, from January 2013 to November 2018 were included. Two raters reviewed patient charts to detect documentation of in-hospital dysphagia, oral motor dysfunction, motor speech and language impairment, and caregiver burden, using a priori operational definitions for notation and assessment findings. Other variables abstracted included demographics, pre-existing conditions, stroke characteristics, and discharge disposition. Impairment frequencies were obtained by univariate and bivariate analysis and associations by simple logistic regression. Results: A total of 173 patients were stratified into neonates (N=67, mean age 2.9 days, 54 AIS, 15 cerebral sinovenous thrombosis) and children (N=106, mean age 6.5 years, 73 AIS, 35 cerebral sinovenous thrombosis). Derived frequencies of impairments included dysphagia (39% neonates, 41% children); oral motor (6% neonates, 41% children); motor speech (37% children); and language (31% children). Common overlapping impairments included oral motor and motor speech (24%) and dysphagia and motor speech (23%) in children. Associations were found only in children between stroke type (AIS over cerebral sinovenous thrombosis) and AIS severity (more severe deficit at presentation) for all impairments except feeding impairment alone. Caregiver burden was present in 58% patients. Conclusions: For the first time, we systematically report the frequencies and associations of dysphagia, oral motor, motor speech, and language impairment during acute presentation of pediatric stroke, ranging from 30% to 40% for each impairment. Further research is needed to determine long-term effects of these impairments and to design standardized age-specific assessment protocols for early recognition following stroke.

scholarly journals Perinatal thrombosis: implications for mothers and neonates

Hematology ◽  
2015 ◽  
Vol 2015 (1) ◽  
pp. 48-52 ◽  
Author(s):  
Sarah H. O'Brien
Keyword(s):  
Ischemic Stroke ◽  
Treatment Strategies ◽  
Perinatal Period ◽  
Clinical Equipoise ◽  
Arterial Ischemic Stroke ◽  
Perinatal Stroke ◽  
Behavioral Challenges ◽  
Cerebral Sinovenous Thrombosis ◽  
Sinovenous Thrombosis

Abstract Stroke is more likely to occur in the perinatal period than any other time in childhood, and these events can lead to a lifetime of intellectual and motor disabilities, epilepsy, and behavioral challenges. This review describes the epidemiology and natural history of perinatal arterial ischemic stroke (PAIS) and cerebral sinovenous thrombosis (CSVT), risk factors for these complications, recent evidence regarding treatment strategies, and current gaps in knowledge. Existing evidence demonstrates the multifactorial etiology of symptomatic ischemic stroke in neonates, which includes a combination of maternal, delivery, and neonatal factors. The importance of inherited thrombophilia in the pathophysiology and long-term outcomes of perinatal stroke requires additional study. At this time, there is no evidence to support routine extensive thrombophilia screening outside of a research setting. Despite the frequency of perinatal stroke and its association with substantial morbidity, treatment strategies are currently limited, and prevention strategies are nonexistent. Anticoagulation is rarely indicated in PAIS, and more work needs to focus on neuroprotective prevention and alternate treatment strategies. Anticoagulation does appear to be safe in CSVT and may prevent thrombus progression but clinical equipoise remains, and clinical trials are needed to obtain evidence regarding short- and long-term efficacy outcomes.

scholarly journals Impact of Thrombophilia on Risk of Arterial Ischemic Stroke or Cerebral Sinovenous Thrombosis in Neonates and Children

Circulation ◽  
2010 ◽  
Vol 121 (16) ◽  
pp. 1838-1847 ◽  
Author(s):  
Gili Kenet ◽  
Lisa K. Lütkhoff ◽  
Manuela Albisetti ◽  
Timothy Bernard ◽  
Mariana Bonduel ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Arterial Ischemic Stroke ◽  
Cerebral Sinovenous Thrombosis ◽  
Sinovenous Thrombosis

scholarly journals B.3 The incidence of perinatal stroke is 1:1200 births in Southern Alberta: Population-based incidence of disease-specific perinatal stroke

2021 ◽  
Vol 48 (s3) ◽  
pp. S16-S16
Author(s):  
M Dunbar ◽  
J Hodge ◽  
A Floer ◽  
A Kirton
Keyword(s):  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Case Series ◽  
Population Based ◽  
Arterial Ischemic Stroke ◽  
Stroke Incidence ◽  
Perinatal Stroke ◽  
Cerebral Sinovenous Thrombosis ◽  
Southern Alberta ◽  
Disease Specific

Background: Perinatal stroke encompasses six cerebrovascular syndromes which occur between the 20th week of gestation and the 28th post-natal day. Subtypes are neonatal arterial ischemic stroke (NAIS), neonatal cerebral sinovenous thrombosis (CSVT), neonatal hemorrhagic stroke (NHS), arterial presumed perinatal ischemic stroke (APPIS), periventricular venous infarction (PVI), and presumed perinatal hemorrhagic stroke (PPHS). Inconsistent terminology and lack of population-based case series has limited accurate measurement of disease-specific perinatal stroke incidence. Our objective was to define the incidence of the subtypes of perinatal stroke using a population-based cohort. Methods: The Alberta Perinatal Stroke Project is a research cohort established in 2008 in Southern Alberta. Case acquisition included retrospective hospital and ICD code searches (1990-2008) and prospective enrollment from all NICU and neurology/stroke clinics (2008-2017). Results: The overall incidence of perinatal stroke in Southern Alberta was 9.0 cases per 10,000 births, or 1:1200 births. Per 10,000 births, the incidence of each subtype was: NAIS = 3.2 (~1:3000), APPIS =1.2 (~1:8500), PVI = 1.5 (~1:6500), CSVT = 1.0 (~1:9900), NHS = 1.4 (~1/7300), PPHS = 0.1 (1/82,000). Conclusions: The overall incidence of perinatal stroke in Southern Alberta is 1:1200 live births. Population-based sampling of disease-specific states may explain why this rate is much higher than previous estimates

scholarly journals Clinical diversity of cerebral sinovenous thrombosis and arterial ischemic stroke in the neonate: a surveillance study.

2020 ◽  
Author(s):  
Anna-Lisa Sorg ◽  
Mathias Klemme ◽  
Rüdiger von Kries ◽  
Ursula Felderhoff-Müser ◽  
Andreas W. Flemmer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Clinical Symptoms ◽  
Age At Onset ◽  
Arterial Ischemic Stroke ◽  
Generalized Seizures ◽  
Cerebral Sinovenous Thrombosis ◽  
Cerebral Mri ◽  
Incidence Risk ◽  
Sinovenous Thrombosis

Abstract Background Incidence, risk factors, clinical presentation, onset of symptoms and age at diagnosis differ between arterial ischemic stroke (AIS) and cerebral sinovenous thrombosis (CSVT) in the neonate. Distinguishing these two entities early and clinically can be of eminent importance. Methods Active surveillance for AIS and CSVT was performed in 345 German pediatric hospitals. Reported cases were validated with questionnaires. Only cases confirmed by cerebral MRI were included in our analysis. Both groups of patients (AIS and CSVT) were compared with regard to age at diagnose, pattern of clinical symptoms and risk factors. Results Data on 144 AIS and 51 CSVT neonatal cases were collected from 2015 to 2017. The relative risk of AIS was 2.8 [95% CI 2.1; 3.9] times higher compared to CSVT. CSVT patients were more likely to be born premature (CSVT 14/48, 29.2%; AIS 19/140, 13.2%; p = 0.02), to have signs of perinatal acidosis (e.g. umbilical artery pH ≤ 7.1 30.2% CSVT vs. 13.5% AIS p = 0.01). Generalized seizures and lethargy were more likely to occur in infants with CSVT (p < 0.0001). Age at onset of symptoms and at time of diagnoses was shifted to older ages in CSVT (p < 0.0001). Conclusion The risk for AIS is about three times higher than for CSVT in neonates. A higher proportion of critically ill infants in CSVT and a later onset of symptoms may indicate that perinatal and postnatal risk factors are more important for CSVT than for AIS. The data point to the need for awareness of CSVT in critical ill infants.

Neonatal Arterial Ischemic Stroke and Cerebral Sinovenous Thrombosis Are More Commonly Diagnosed in Boys

2004 ◽  
Vol 19 (7) ◽  
pp. 493-497 ◽  
Author(s):  
Meredith R. Golomb ◽  
Paul T. Dick ◽  
Daune L. MacGregor ◽  
Rosalind Curtis ◽  
Marianne Sofronas ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Arterial Ischemic Stroke ◽  
Cerebral Sinovenous Thrombosis ◽  
Sinovenous Thrombosis

Diffusion imaging of cerebral diaschisis in childhood arterial ischemic stroke

2016 ◽  
Vol 11 (9) ◽  
pp. 1028-1035 ◽  
Author(s):  
Adam Kirton ◽  
Elizabeth Williams ◽  
Michael Dowling ◽  
Sarah Mah ◽  
Jacquie Hodge ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Diffusion Weighted Imaging ◽  
Infarct Volume ◽  
Resonance Imaging ◽  
Arterial Ischemic Stroke ◽  
Diffusion Weighted ◽  
Motor Outcome

Background Diffusion-weighted imaging magnetic resonance imaging may detect changes in brain structures remote but connected to stroke consistent with neuropathological descriptions of diaschisis. Early diffusion-weighted imaging demonstrates restriction in corticospinal pathways after arterial ischemic stroke of all ages that correlates with motor outcome. Aim/hypothesis We hypothesized that cerebral diaschisis is measurable in childhood arterial ischemic stroke and explored associations with outcome. Methods This sub-study of the validation of the Pediatric NIH Stroke Scale study prospectively enrolled children with acute arterial ischemic stroke and both acute and early follow-up (5–14 days) diffusion-weighted imaging. Inclusion criteria were (1) unilateral middle cerebral artery arterial ischemic stroke, (2) acute and subacute diffusion-weighted imaging ( b = 1000), and (3) 12 month neurological follow-up (Pediatric Stroke Outcome Measure). A validated method using ImageJ software quantified diffusion-weighted imaging diaschisis in anatomically connected structures. Diaschisis measures were corrected for infarct volume, compared to age, imaging timing, and outcomes (Chi square/Fisher, Mann–Whitney test). Results Nineteen children (53% male, median 8.1 years) had magnetic resonance imaging at medians of 21 and 168 h post-stroke onset. Diaschisis was common and evolved over time, observed in one (5%) on acute but eight (42%) by follow-up diffusion-weighted imaging. Thalamic and callosal diaschisis were most common (5, 26%). Estimates of perilesional diaschisis varied (54 ± 18% of infarct volume). Children with diaschisis tended to be younger (7.02 ± 5.4 vs. 11.82 ± 4.3 years, p = 0.08). Total diaschisis score was associated with poor cognitive outcomes ( p = 0.03). Corticospinal tract diaschisis was associated with motor outcome ( p = 0.004). Method reliability was excellent. Conclusions Diffusion-weighted imaging diaschisis occurs in childhood arterial ischemic stroke. Mistaking diaschisis for new areas of infarction carries important clinical implications. Improved recognition and study are required to establish clinical relevance.

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