Diagnosing and Treating Childhood Stroke

The main reason for this, she said, is that there is a low awareness of pediatric stroke. Studies have shown that the initial clinician suspects arterial ischemic stroke (AIS) in just 43% of cases, while the initial CT scan misses AIS in at least 40% of cases.

“Our new protocol, and I think this needs to be widespread, is our first test is MRI,” she stated.

The second biggest clinical challenge is the practice of selecting treatments. “We have a number of guidelines available for the practicing clinician, but none of these is based on really strong evidence,” Dr. deVeber said.

The two main treatment options are anticoagulant therapies and antiplatelet monotherapy. Among the 661 cases of children with AIS in the IPSS database, the primary course of treatment varied greatly from country to country. In Canada, for instance, 59% of cases were treated with anticoagulant therapy, 19% were treated with antiplatelet monotherapy, and 22% received no treatment. In the United States, 38% received anticoagulants, 28% received antiplatelets, and 34% went untreated.

“What is very troubling is the portion who received no therapy,” she said. “We need to work very hard in this area.”

The Future of Pediatric Stroke

Dr. deVeber foresees “continued rapid expansion and growth [in this field], with pediatric stroke representing an important, emerging subspecialty within pediatric neurology.”

Areas that still need to be addressed include the “implementation of neuroprotective care for the stroke-in-evolution, including control of seizures, fever, and low blood pressure, all of which may worsen the original infarct,” she said. “Second, we need to find better ways of preventing recurrent stroke, which still affects 10% to 15% of children with initial stroke after the newborn period.

“The field of pediatric stroke represents a success story involving multinational collaborations in the IPSS over many years and many key investigators,” she added. “In the future, I hope that clinical trials will be started and I’d like to see them combined with adult stroke research so we can bridge that 18-year gap. I also think data from young-adult stroke studies are going to be a very fertile source of information for understanding childhood stroke."
—Rebecca K. Abma