Childhood strokes

Abstract

Strokes in childhood, although relatively uncommon, have high rates of morbidity and mortality. The clinical findings of ischemic and hemorrhagic strokes are reviewed; both have a significant recurrence risk while the latter carries a particularly high mortality, although outcome in survivors may be better. Neonatal strokes also have to be considered and have variable outcome, although death and recurrence are uncommon. Risk factors for childhood strokes differ from those causing strokes in adults. Cardiac and blood disorders, for instance congenital heart disease and sickle cell disease, are obvious examples, and now more attention is being given to coagulation and metabolic disorders. Infections, especially those due to viruses such as varicella, can precipitate strokes in children, and there are a number of genetically determined conditions, that can lead to strokes. The latter include blood and metabolic diseases, as well as mitochondrial disorders, which can mimic childhood strokes. Other mimics may also be serious but others are not, such as migraine and syncope. The management of children who have suffered a stroke has to be considered in both the short and long term. For ischemic stroke, management considerations include the use of aspirin, anticoagulants and thrombolytic agents, while hemorrhagic stroke may require emergency neurosurgery and a multidisciplinary team to reduce the risk of recurrence. Rehabilitation requires the involvement of a variety of therapists and needs further study, but assessment of affected children for special educational needs will almost certainly be required.

Keywords

Childhood - stroke - management