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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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Autor principal: Kirkham, Fenella
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medicine Pub 2010
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
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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.
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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
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