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Investigation and management of childhood stroke
It is now clear that a number of paediatric emergencies with a neurological presentation, including hemiparesis, visual loss, seizures and coma, commonly have a vascular basis which may not be obvious on CT scan. Although many children do well, as there is significant mortality as well as morbidity...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medicine Pub
2010
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534439/ https://www.ncbi.nlm.nih.gov/pubmed/23293663 http://dx.doi.org/10.1016/j.paed.2010.08.005 |
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author | Kirkham, Fenella |
author_facet | Kirkham, Fenella |
author_sort | Kirkham, Fenella |
collection | PubMed |
description | It is now clear that a number of paediatric emergencies with a neurological presentation, including hemiparesis, visual loss, seizures and coma, commonly have a vascular basis which may not be obvious on CT scan. Although many children do well, as there is significant mortality as well as morbidity for childhood stroke, in addition to a high risk for recurrence, making a diagnosis in the acute phase important. Venography and arteriography (including the neck vessels if the intracranial vessels are normal) are usually indicated despite the problems i.e. contrast CT requires a high dose of radiation while emergency MR usually requires anaesthesia and conventional arteriography carries a small risk of stroke. Surgical decompression may be life-saving in ischaemic as well as haemorrhagic stroke. It is unusual for children with anterior circulation stroke to be triaged quickly enough (<4.5 h) for thrombolysis but this may occasionally be appropriate in posterior circulation occlusion associated with coma, where the time window is longer (<12 h). Anticoagulation carries relatively low risk and may be of benefit for children with venous sinus thrombosis (acutely and when at risk subsequently) or extracranial dissection. Aspirin to attempt to reduce the recurrence risk is appropriate in the medium term for the majority of patients with arterial ischaemic stroke. Iron and B vitamin deficiencies should be excluded or treated. |
format | Online Article Text |
id | pubmed-3534439 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2010 |
publisher | Medicine Pub |
record_format | MEDLINE/PubMed |
spelling | pubmed-35344392013-01-03 Investigation and management of childhood stroke Kirkham, Fenella Paediatr Child Health (Oxford) Symposium: Neurology It is now clear that a number of paediatric emergencies with a neurological presentation, including hemiparesis, visual loss, seizures and coma, commonly have a vascular basis which may not be obvious on CT scan. Although many children do well, as there is significant mortality as well as morbidity for childhood stroke, in addition to a high risk for recurrence, making a diagnosis in the acute phase important. Venography and arteriography (including the neck vessels if the intracranial vessels are normal) are usually indicated despite the problems i.e. contrast CT requires a high dose of radiation while emergency MR usually requires anaesthesia and conventional arteriography carries a small risk of stroke. Surgical decompression may be life-saving in ischaemic as well as haemorrhagic stroke. It is unusual for children with anterior circulation stroke to be triaged quickly enough (<4.5 h) for thrombolysis but this may occasionally be appropriate in posterior circulation occlusion associated with coma, where the time window is longer (<12 h). Anticoagulation carries relatively low risk and may be of benefit for children with venous sinus thrombosis (acutely and when at risk subsequently) or extracranial dissection. Aspirin to attempt to reduce the recurrence risk is appropriate in the medium term for the majority of patients with arterial ischaemic stroke. Iron and B vitamin deficiencies should be excluded or treated. Medicine Pub 2010-09 /pmc/articles/PMC3534439/ /pubmed/23293663 http://dx.doi.org/10.1016/j.paed.2010.08.005 Text en © 2010 Elsevier Ltd. https://creativecommons.org/licenses/by/4.0/ Open Access under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/) license |
spellingShingle | Symposium: Neurology Kirkham, Fenella Investigation and management of childhood stroke |
title | Investigation and management of childhood stroke |
title_full | Investigation and management of childhood stroke |
title_fullStr | Investigation and management of childhood stroke |
title_full_unstemmed | Investigation and management of childhood stroke |
title_short | Investigation and management of childhood stroke |
title_sort | investigation and management of childhood stroke |
topic | Symposium: Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534439/ https://www.ncbi.nlm.nih.gov/pubmed/23293663 http://dx.doi.org/10.1016/j.paed.2010.08.005 |
work_keys_str_mv | AT kirkhamfenella investigationandmanagementofchildhoodstroke |