Treatment of arterial ischemic stroke in children
Children's National Medical Center, Department of Neurology, Washington, DC 20010, USA. Expert Review of Neurotherapeutics
(Impact Factor: 2.78).
04/2007; 7(4):383-92. DOI: 10.1586/1473718.104.22.1683
Stroke is a rare but increasingly recognized disorder in children. Current therapies for arterial ischemic stroke include thrombolytic, antithrombotic and antiplatelet agents, blood transfusion and surgery. Adult studies, pediatric case studies and expert opinion form the basis for these treatment strategies. Thrombolytic agents are increasingly used but, as in adults, the majority of arterial ischemic strokes in children are treated with antiplatelet and antithrombotic agents. Sickle-cell patients, a distinct subset of the pediatric stroke population, are treated primarily with transfusion therapy. Pediatric arterial ischemic stroke studies are needed to determine the most appropriate course of treatment. An international study is currently in progress to formally study the incidence, risk factors, treatment strategies and outcomes of stroke in children.
Available from: macpeds.com
- "Fever should be controlled. Hyperthermia has been associated with increased secondary injury in multiple animal models of stroke . Seizures should be aggressively treated. "
Available from: PubMed Central
- "One study showed 1.6% of pediatric AIS patients admitted between 2000 and 2003 received thrombolytic therapy.1 The children receiving thrombolytics had significantly higher medical costs, were less likely to be discharged home and had higher overall mortality rates.1 Shortcomings of these findings were noted, including the small sample size and unknown severity of any of the patients at the time of presentation. Conversely, several case reports have been published showing potential benefits using thrombolytic therapy in children, including success stories across a wide age range and administration of thrombolytics well outside of the standard three-hour window used in adults.11,12 "
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ABSTRACT: Acute ischemic stroke in a pediatric patient is a complex disease with a variety of etiologies that differ from adults. Though rare, they are a real phenomenon with potentially devastating consequences. Some treating institutions are using anti-thrombotic drug therapy with unclear benefits. Available literature, which is limited to case reports and retrospective reviews of databases, clouds this topic with both positive and negative outcomes. Emergency department management should focus on stabilization and resuscitation with immediate involvement of a pediatric neurologist and intensivist. The decision to use anti-thrombotic drug therapy, including anti-platelet drugs and thrombolytics, should be in consult with the specialists involved until randomized controlled trials determine their safety and efficacy in the pediatric population.
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ABSTRACT: Stroke is a rare but increasingly recognized disorder in children. Lack of published clinical trials and experience in most institutions has resulted in significant challenges for clinicians who manage children with stroke. We report a case of 16-year-old male child who was presented with history of sudden onset of weakness 2 months back and before he could consult the physician, the weakness improved significantly and a misdiagnosis of functional disorder was made at a peripheral hospital. Children with stroke may have subtle manifestations and to make an early diagnosis of stroke in children there is need of awareness about this entity in children.
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