Pediatric stroke

Abstract

Over the last two decades, childhood ischemic stroke, including arterial ischemic stroke and cerebral sinovenous thrombosis (CSVT), has been increasingly recognized. Despite the widely held belief that the increased plasticity of the young brain protects against the effects of injury, early brain injury due to stroke commonly results in significant long-term impairment. Considerable differences exist between stroke in childhood and adults. These include maturational changes of the vascular, coagulation, and nervous systems in neonates, older infants, children, and adults. In addition, etiology differs significantly from adulthood. Presenting symptoms and clinical findings vary with the age of the child. Finally, imaging may be more challenging with high rates of falsely negative CT scans and a large number of clinical stroke mimics to consider. Together with a general lack of awareness, these factors frequently result in significant delays in recognition and appropriate investigation and treatment. Due to different underlying mechanisms and important developmental changes throughout childhood, neuroimaging and management decisions in pediatric stroke cannot be simply extrapolated from adults. MRI imaging plays a crucial role in pediatric stroke in order to detect and characterize an ischemic lesion and exclude common stroke mimics. It also provides valuable information about the potential etiology and prognosis. This in turn guides further diagnostic steps and assists in treatment decisions. In the near future, more sophisticated imaging techniques such as vessel wall imaging, DTI, and functional imaging techniques will likely emerge into the clinical arena and play an important role in enhancing our understanding of pediatric stroke.