Pediatric stroke

Abstract

Stroke in pediatrics is an underdiagnosed neurological emergency. Only 48% of strokes are diagnosed in the acute phase. Diagnosis is often delayed. As a result, survivors will present significant sequels in terms of motor, cognitive and language impairment. Upon the presence of warning signs of less than 24 hours of evolution, the «pediatric stroke code» should be activated. This strategy has already been implemented in some centers of the national hospital network. The clinical manifestations of suspected stroke in children are very unspecific. Ideally, a validated biomarker panel would be available to aid diagnosis. Neonatal hypoxic-ischemic encephalopathy is the pediatric neurovascular pathology on which biomarker studies have focused the most. Stroke classification is dependent on the nature of the brain injury (ischemic or hemorrhagic), and on the age of the child: perinatal (between 20 gestational weeks and 28 postnatal days), and postnatal (between day 28 and 15-19 years). The biomarkers with the greatest potential are associated with nervous tissue: S100 calcium-binding protein (S100B), neuron specific enolase (NSE), glial fibrillary acidic protein (GFAP), ubiquitin carboxyterminal hydrolase L1 (UCHL-1), and activin A; the neurovascular system: adrenomedulin (AM); inflammation: interleukin-6 (IL-6); and oxidative stress: F2-isoprostanes. On the other hand, a later complementary test, such as genetic panels, will provide information on the stroke etiology.