- Assess level of consciousness and stabilize.
- Assess for focal neurologic deficits.
- Determine time the child was last known well.
- Trigger pediatric stroke team (if available).
- Obtain MRI of brain without contrast and time-of-flight magnetic resonance angiogram (MRA).
- If MRI not available, order noncontrast head CT.
- Obtain intravenous (IV) access and determine if thrombolytic treatment (tissue plasminogen activator [tPA]) and/or thrombectomy is indicated (see Therapy section).
Childhood stroke is defined by onset between 29 days and 18 years of life. Perinatal stroke, defined as onset at 28 days or earlier, is discussed separately.
Childhood stroke has an incidence of 2-13 per 100 000. Approximately one-half of cases are classified as ischemic stroke, and one-half are classified as hemorrhagic stroke. Children with stroke often present with an acute focal neurologic deficit such as hemiparesis; they may also present with focal seizure.
Common risk factors for childhood stroke include arteriopathy (eg, Moyamoya disease), cardiac disease (eg, congenital cardiac defects), and prothrombotic disorders. Infections, sickle cell disease, and genetic or metabolic disorders can also predispose to stroke.
In arterial ischemic stroke, children present with a focal neurologic deficit that corresponds to a region of ischemia in the brain. Cerebral arteriopathy is the cause of approximately one-half of arterial ischemic strokes in children.
In hemorrhagic stroke, children present with focal neurologic deficit, often due to intraparenchymal and/or subarachnoid hemorrhage. Common causes of pediatric hemorrhagic stroke include arteriovenous malformation (AVM), cavernous malformation, or aneurysm. It can be difficult to differentiate ischemic from hemorrhagic stroke from the initial history and examination in children, so imaging is required.
Cerebral sinovenous thrombosis can also present with ischemic or hemorrhagic stroke in children; see cerebral venous thrombosis.
Related topic: drug-induced stroke