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BACKGROUND AND EPIDEMIOLOGY

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DIFFERENCES FROM STROKE IN ADULTS

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  • Immature neuraxis

    • Causes subtle exam findings, leading to delay in diagnosis

      • Stroke must be considered in any patient with acute neurologic deficit

  • Risk factors for stroke are different compared to adults

    • Atherosclerosis is not common cause of stroke in children

    • There are no randomized, controlled therapeutic trials in children

  • Type of stroke: Arterial ischemic stroke (AIS), hemorrhagic stroke (HS), cerebral venous sinus thrombosis (CVST)

  • Prompt recognition: Allows for optimization of cerebral perfusion and can minimize secondary injury

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EPIDEMIOLOGY

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  • Pediatric stroke (age 30 days–18 years): annual average incidence of 1.6 to 13/100,0001,2

  • Arterial ischemic stroke (including CVST):

    • 50% to 70% of pediatric strokes

    • Comprises 15% of all ischemic strokes that occur in young adults and adolescents

    • Mortality after AIS ranges from 10% to 15% with 50% of survivors left with a neurologic deficit

    • Risk for recurrence ranges from 1% to 20%3

  • Hemorrhagic stroke:

    • 41% to 49% of pediatric strokes

    • Two to three times the incidence of adults

    • Median age is 5 to 10 years

    • Males are at slightly higher risk (55% to 60%)

    • Mortality is lower in children than adults. While survival is greater, morbidity among survivors is high

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RISK FACTORS (TABLE 43-1)

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CONSIDERATIONS

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  • Many patients have multiple risk factors, whereas 10% to 38% have no risk factor identified2,4

  • Recurrent stroke increased if multiple risk factors identified5

  • Chromosomal mutations (trisomy 21), genetic syndromes (Sturge Weber), and single-gene disorders (sickle cell) may predispose to stroke

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Table Graphic Jump Location
TABLE 43-1

Risk Factors Identified in Pediatric Stroke

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AIS

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  • Arteriopathies: Identified in 31% to 60% of patients6

    • Nontraumatic dissections, vasculitis, moyamoya, postvaricella arteriopathy, primary vascular disorder, sickle cell disease, transient arteriopathies (recent viral infections)

    • Vasculopathy: Increases risk of stroke recurrence, especially in the first 6 months after stroke presentation7

  • Congenital heart disease8

    • Highest stroke risk after ...

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