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Stroke is a very uncommon (incidence in infants and children 0.6 to 7.9/100,000 per year), but devastating illness in children and young adults. Stroke does have a male predominance in children of which the cause is unknown. A high clinical suspicion of stroke in patients presenting with concerning symptoms is key to the diagnosis of this disease process.
The etiologies for stroke in children and adolescents vary greatly from the adult population. More than have of patients are previously healthy with no known risk factors. The most prevalent independent risk factor for stroke the week prior to the event is recent infection.
One of the key drives of outcomes in acute stroke management is early evaluation and treatment of stroke with supportive and reversible therapies. In the adult literature rapid assessment measures ("Stroke Codes") have been shown to improve outcomes in patients. The pediatric literature has shown that the median time from presentation to diagnosis of stroke in children is almost 24 hours, with in-hospital delays accounting
for the largest proportion of this time. Pediatric patients would likely benefit from similar systems of early, rapid assessment and care as adults.
Besides initial resuscitation measures, there are specific issues related to stroke that should be immediately implemented in patients where stroke is of concern. Many of these measures are brought from the adult literatures as there have been few studies in the pediatric literature.
There have been very few studies on using IV thrombolysis for the treatment of stroke in children. The decision to use thrombolysis should be done in close consultation with a pediatric neurologist.
There is little literature about the use of mechanical thrombectomy in the treatment of pediatric stroke. Close consultation with pediatric neurology and interventional radiology should be considered in cases where thrombectomy may be useful.
The clinical presentation of acute stroke may be subtle and sometimes confusing. Patients with unexplained seizures, altered mental status and focal weakness should be strongly considered for acute stroke. Younger children are more likely to present with global findings (seizures, altered mental status) rather than older children who more often present with focal findings. In patients with subtle findings, emergent consultation with a pediatric neurologist may be useful.