Evaluation and Management of the Child With Suspected Acute Stroke

Pediatric stroke occurs at an incidence of 1.6 to 13/100 000 and may be acute ischemic, hemorrhagic, or of sinus venous thrombosis etiology. As these children present to the emergency department, early consideration for this diagnosis is paramount towards optimizing cerebral perfusion and minimizing secondary injury. There are many identified risk factors in pediatric stroke including arteriopathies, cardiac disease (specifically congenital heart disease), and infection. The most common presenting sign of acute ischemic stroke in all pediatric age groups is a focal neurologic deficit, typically acute hemiplegia. Imaging, specifically magnetic resonance imaging, as well as identification of risk factors will help aid diagnosis and treatment. Treatment for acute ischemic stroke in pediatrics focuses on minimizing injury and preventing early complications by maintaining cerebral perfusion pressure. Hemorrhagic stroke may need acute neurosurgical intervention. Overall outcome of pediatric stroke is good, but long-term complications including depression should be recognized and treated appropriately.