Skip to main content

Advertisement

SpringerLink
Log in

Acute Stroke Treatment in Children: Are Adult Guidelines Applicable?

  • Cerebrovascular Disorders (D Jamieson, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

A Correction to this article was published on 11 April 2022

This article has been updated

Abstract

Purpose of Review

This article provides an overview of acute treatments in stroke which are widely studied and available for adults and their applicability in the pediatric population.

Recent Findings

Arterial ischemic stroke is an important cause of morbidity and mortality in the pediatric population. Neurological deficits and etiologies are age-dependent and more challenging to diagnose than in the adult population. Advancements in imaging and treatment modalities including increased treatment windows in acute stroke have led to improvement in the diagnosis and management of pediatric arterial ischemic disease. Accordingly, hyperacute treatments, such as endovascular therapy, are becoming increasingly available in an attempt to improve outcomes in children.

Summary

Significant scientific and technological advances have transformed the hyperacute treatment of stroke in the recent years, allowing for improvement in the diagnosis and treatment of cerebrovascular pathologies in children. Optimization in the approach and validation of existing stroke pathways/protocols are expected to further advance acute stroke therapy in pediatric patient care. Given that the lifelong individual, family, and societal burden of acute stroke is likely to be greater than in adults because infants and children surviving stroke live more years with disability, we must be knowledgeable about this pathology and the medical and therapeutic options available for this unique population as detailed in this review.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

All data relevant to the study are included in the article.

Change history

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Goeggel Simonetti B, Cavelti A, Arnold M, Bigi S, Regenyi M, Mattle HP, et al. Long-term outcome after arterial ischemic stroke in children and young adults. Neurology. 2015;84(19):1941-7.

  2. Ciccone S, Cappella M, Borgna-Pignatti C. Ischemic stroke in infants and children: practical management in emergency. Stroke Res Treat. 2011;2011:736965.

  3. •• Ferriero DM, Fullerton HJ, Bernard TJ, Billinghurst L, Daniels SR, DeBaun MR, et al. Management of stroke in neonates and children: a scientific statement from the American Heart Association/American Stroke Association. Stroke. 2019;50(3):e51-e96. Current American Heart Association/American Stroke Association guidelines in the management of stroke in neonates and children.

  4. Uohara MY, Beslow LA, Billinghurst L, Jones BM, Kessler SK, Licht DJ, et al. Incidence of recurrence in posterior circulation childhood arterial ischemic stroke. JAMA Neurol. 2017;74(3):316-23.

  5. Jordan LC, Hillis AE. Challenges in the diagnosis and treatment of pediatric stroke. Nat Rev Neurol. 2011;7(4):199-208.

  6. Tsze DS, Valente JH. Pediatric stroke: a review. Emerg Med Int. 2011;2011:734506.

  7. Kazmi SO, Sivakumar S, Karakitsos D, Alharthy A, Lazaridis C. Cerebral pathophysiology in extracorporeal membrane oxygenation: pitfalls in daily clinical management. Crit Care Res Pract. 2018;2018:3237810.

  8. McGlennan C, Ganesan V. Delays in investigation and management of acute arterial ischaemic stroke in children. Dev Med Child Neurol. 2008;50(7):537-40.

  9. Amlie-Lefond C, Wainwright MS. Organizing for acute arterial ischemic stroke in children. Stroke. 2019;50(12):3662-8.

  10. Steinlin M, Pfister I, Pavlovic J, Everts R, Boltshauser E, Capone Mori A, et al. The first three years of the Swiss Neuropaediatric Stroke Registry (SNPSR): a population-based study of incidence, symptoms and risk factors. Neuropediatrics. 2005;36(2):90-7.

  11. Christerson S, Strömberg B. Childhood stroke in Sweden I: incidence, symptoms, risk factors and short-term outcome. Acta Paediatr. 2010;99(11):1641-9.

  12. Mallick AA, Ganesan V, Kirkham FJ, Fallon P, Hedderly T, McShane T, et al. Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study. Lancet Neurol. 2014;13(1):35-43.

  13. Ichord RN, Bastian R, Abraham L, Askalan R, Benedict S, Bernard TJ, et al. Interrater reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a multicenter study. Stroke. 2011;42(3):613-7.

  14. Beslow LA, Kasner SE, Smith SE, Mullen MT, Kirschen MP, Bastian RA, et al. Concurrent validity and reliability of retrospective scoring of the Pediatric National Institutes of Health Stroke Scale. Stroke. 2012;43(2):341-5.

  15. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581-7.

  16. Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317-29.

  17. Amlie-Lefond C, deVeber G, Chan AK, Benedict S, Bernard T, Carpenter J, et al. Use of alteplase in childhood arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol. 2009;8(6):530-6.

  18. Rivkin MJ, deVeber G, Ichord RN, Kirton A, Chan AK, Hovinga CA, et al. Thrombolysis in pediatric stroke study. Stroke. 2015;46(3):880-5.

  19. See AP, Kochis MA, Khandelwal P, Orbach DB. Considerations in applying a new stent retriever in pediatric endovascular cerebral thrombectomy for acute ischemic stroke. Pediatr Neurosurg. 2016;51(5):263-8.

  20. Bhogal P, Hellstern V, AlMatter M, Ganslandt O, Bazner H, Aguilar Perez M, et al. Mechanical thrombectomy in children and adolescents: report of five cases and literature review. Stroke Vasc Neurol. 2018;3(4):245-52.

  21. Bhatia K, Kortman H, Blair C, Parker G, Brunacci D, Ang T, et al. Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series. J Neurosurg Pediatr. 2019:1-14.

  22. Pacheco JT, Siepmann T, Barlinn J, Winzer S, Penzlin AI, Puetz V, et al. Safety and efficacy of recanalization therapy in pediatric stroke: a systematic review and meta-analysis. Eur J Paediatr Neurol. 2018;22(6):1035-41.

  23. Satti S, Chen J, Sivapatham T, Jayaraman M, Orbach D. Mechanical thrombectomy for pediatric acute ischemic stroke: review of the literature. J Neurointerv Surg. 2017;9(8):732-7.

  24. Wilson JL, Eriksson CO, Williams CN. Endovascular therapy in pediatric stroke: utilization, patient characteristics, and outcomes. Pediatr Neurol. 2017;69:87-92 e2.

  25. Bigi S, Dulcey A, Gralla J, Bernasconi C, Melliger A, Datta AN, et al. Feasibility, safety, and outcome of recanalization treatment in childhood stroke. Ann Neurol. 2018;83(6):1125-32.

  26. • Shoirah H, Shallwani H, Siddiqui AH, Levy EI, Kenmuir CL, Jovin TG, et al. Endovascular thrombectomy in pediatric patients with large vessel occlusion. J Neurointerv Surg. 2019;11(7):729-32. Critical multi-center study evaluating endovascular thrombectomy in pedatric patients with large vessel occulsion.

  27. • Van Es A, Hunfeld MAW, van den Wijngaard I, Kraemer U, Engelen M, van Hasselt B, et al. Endovascular treatment for acute ischemic stroke in children: experience from the MR CLEAN Registry. Stroke. 2021;52(3):781-8. Description of the pediatric acute ischemic stroke thrombectomy experience in MR CLEAN Registry.

  28. Hoffman CE, Santillan A, Rotman L, Gobin YP, Souweidane MM. Complications of cerebral angiography in children younger than 3 years of age. J Neurosurg Pediatr. 2014;13(4):414-9.

  29. •• Chaudhary N, Elijovich L, Martinez M, Fifi JT, Ortega-Gutierrez S, Shaibani A, et al. Pediatric diagnostic cerebral angiography: practice recommendations from the SNIS Pediatric Committee. J Neurointerv Surg. 2021;13(8):762-6. Landmark guidelines in pediatric diagnostic cerebral angiography from the SNIS Pediatric Committee.

  30. Fifi JT, Meyers PM, Lavine SD, Cox V, Silverberg L, Mangla S, et al. Complications of modern diagnostic cerebral angiography in an academic medical center. J Vasc Interv Radiol. 2009;20(4):442-7.

  31. Fung E, Ganesan V, Cox TS, Chong WK, Saunders DE. Complication rates of diagnostic cerebral arteriography in children. Pediatr Radiol. 2005;35(12):1174-7.

  32. Burger IM, Murphy KJ, Jordan LC, Tamargo RJ, Gailloud P. Safety of cerebral digital subtraction angiography in children: complication rate analysis in 241 consecutive diagnostic angiograms. Stroke. 2006;37(10):2535-9.

  33. Barr JD. Cerebral angiography in the assessment of acute cerebral ischemia: guidelines and recommendations. J Vasc Interv Radiol. 2004;15(1 Pt 2):S57-66.

  34. Arlachov Y, Ganatra RH. Sedation/anaesthesia in paediatric radiology. Br J Radiol. 2012;85(1019):e1018-31.

  35. Andreucci M. Side effects of radiographic contrast media. Biomed Res Int. 2014;2014:872574.

  36. Andreucci M, Solomon R, Tasanarong A. Side effects of radiographic contrast media: pathogenesis, risk factors, and prevention. Biomed Res Int. 2014;2014:741018.

  37. Castro D, Martin Lee LAM, Bhutta BS. Femoral Vein Central Venous Access. StatPearls. Treasure Island (FL)2021.

  38. Griauzde J, Gemmete JJ, Shastri R, Pandey AS, Chaudhary N. Use of the 2.8 French Progreat microcatheter in diagnostic cerebral angiography. J Neurointerv Surg. 2017;9(1):88-91.

  39. Kutanzi KR, Lumen A, Koturbash I, Miousse IR. Pediatric Exposures to ionizing radiation: carcinogenic considerations. Int J Environ Res Public Health. 2016;13(11).

  40. Strauss KJ, Kaste SC. The ALARA (as low as reasonably achievable) concept in pediatric interventional and fluoroscopic imaging: striving to keep radiation doses as low as possible during fluoroscopy of pediatric patients--a white paper executive summary. Radiology. 2006;240(3):621-2.

  41. Kwiatkowski JL, Voeks JH, Kanter J, Fullerton HJ, Debenham E, Brown L, et al. Ischemic stroke in children and young adults with sickle cell disease in the post-STOP era. Am J Hematol. 2019;94(12):1335-43.

  42. Smith JL. Understanding and treating moyamoya disease in children. Neurosurg Focus. 2009;26(4):E4.

  43. Beslow LA, Jordan LC. Pediatric stroke: the importance of cerebral arteriopathy and vascular malformations. Childs Nerv Syst. 2010;26(10):1263-73.

  44. Lanthier S, Armstrong D, Domi T, deVeber G. Post-varicella arteriopathy of childhood: natural history of vascular stenosis. Neurology. 2005;64(4):660-3.

  45. Sebire G, Meyer L, Chabrier S. Varicella as a risk factor for cerebral infarction in childhood: a case-control study. Ann Neurol. 1999;45(5):679-80.

  46. Gao P, Dmytriw AA, Wang T, Krings T, Ren J, Chen F, et al. Contemporary challenges of acute ischemic stroke in Takayasu arteritis. Stroke. 2020;51(10):e280-e4.

  47. Prangwatanagul W, Limsuwan A. Ischemic stroke in Kawasaki disease. Pediatr Int. 2017;59(1):92-6.

  48. Venkatesan C, Wainwright MS. Pediatric endocarditis and stroke: a single-center retrospective review of seven cases. Pediatr Neurol. 2008;38(4):243-7.

  49. Wang D, Liu M, Lin S, Hao Z, Tao W, Chen X, et al. Stroke and rheumatic heart disease: a systematic review of observational studies. Clin Neurol Neurosurg. 2013;115(9):1575-82.

  50. deVeber G, Kirkham F, Shannon K, Brandao L, Strater R, Kenet G, et al. Recurrent stroke: the role of thrombophilia in a large international pediatric stroke population. Haematologica. 2019;104(8):1676-81.

  51. Sultan SM, Schupf N, Dowling MM, Deveber GA, Kirton A, Elkind MS. Review of lipid and lipoprotein(a) abnormalities in childhood arterial ischemic stroke. Int J Stroke. 2014;9(1):79-87.

  52. Noje C, Cohen K, Jordan LC. Hemorrhagic and ischemic stroke in children with cancer. Pediatr Neurol. 2013;49(4):237-42.

  53. Khan NR, Fraser BD, Nguyen V, Moore K, Boop S, Vaughn BN, et al. Pediatric abusive head trauma and stroke. J Neurosurg Pediatr. 2017;20(2):183-90.

  54. Kirton A, Crone M, Benseler S, Mineyko A, Armstrong D, Wade A, et al. Fibromuscular dysplasia and childhood stroke. Brain. 2013;136(Pt 6):1846-56.

  55. Van Beynum IM, Smeitink JA, den Heijer M, te Poele Pothoff MT, Blom HJ. Hyperhomocysteinemia: a risk factor for ischemic stroke in children. Circulation. 1999;99(16):2070-2.

  56. Wityk RJ, Zanferrari C, Oppenheimer S. Neurovascular complications of marfan syndrome: a retrospective, hospital-based study. Stroke. 2002;33(3):680-4.

  57. Khandanpour N, Connolly DJ, Raghavan A, Griffiths PD, Hoggard N. Craniospinal abnormalities and neurologic complications of osteogenesis imperfecta: imaging overview. Radiographics. 2012;32(7):2101-12.

  58. Ravindra VM, Alexander M, Taussky P, Bollo RJ, Hassan AE, Scoville JP, et al. Endovascular thrombectomy for pediatric acute ischemic stroke: a multi-institutional experience of technical and clinical outcomes. Neurosurgery. 2020;88(1):46-54.

  59. Sporns PB, Straeter R, Minnerup J, Wiendl H, Hanning U, Chapot R, et al. Does device selection impact recanalization rate and neurological outcome? an analysis of the Save ChildS Study. Stroke. 2020;51(4):1182-9.

  60. Fragata I, Morais T, Silva R, Nunes AP, Loureiro P, Diogo Martins J, Pamplona J, Carvalho R, Baptista M, Reis J. Endovascular treatment of pediatric ischemic stroke: A single center experience and review of the literature. Interv Neuroradiol. 2021;(1):16-24. https://doi.org/10.1177/1591019920958827. Epub 2020 Sep 9.PMID: 32903115

Download references

Funding

The paper was supported by the National Institute of Health (NIH) grant number RO1 NS127114-01.

Author information

Author notes

  1. Waldo R. Guerrero and Sudeepta Dandapat contributed equally

Authors and Affiliations

  1. Department of Neurosciences, Aurora Neuroscience Innovation Institute, St. Luke’s Hospital, Milwaukee, WI, USA

    Sudeepta Dandapat MD

  2. Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA

    Waldo R. Guerrero MD

  3. Department of Neurology, Radiology and Neurosurgery, Comprehensive Stroke Center, University of Iowa, Iowa City, IA, USA

    Santiago Ortega-Gutierrez MD, MSc, FAHA, FSVIN

  4. Department of Neurology, Neurosurgery and Radiology, University of Iowa Carver College of Medicine, 200 Hawkins Dr, Iowa City, IA, 52242, USA

    Santiago Ortega-Gutierrez MD, MSc, FAHA, FSVIN

Authors
  1. Sudeepta Dandapat MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Waldo R. Guerrero MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Santiago Ortega-Gutierrez MD, MSc, FAHA, FSVIN
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the conception, data gathering, and drafting of the manuscript, along with any statistical analysis, manuscript oversight and administrative support. All authors critically reviewed the manuscript and approved its final submission.

Corresponding author

Correspondence to Santiago Ortega-Gutierrez MD, MSc, FAHA, FSVIN.

Ethics declarations

Conflict of Interest

Sudeepta Dandapat declares that he has no conflict of interest. Waldo R. Guerrero declares that he has no conflict of interest. Santiago Ortega-Gutierrez declares that he has no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Cerebrovascular Disorders

The original online version of this article was revised to add the NIH funding statement.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dandapat, S., Guerrero, W.R. & Ortega-Gutierrez, S. Acute Stroke Treatment in Children: Are Adult Guidelines Applicable?. Curr Treat Options Neurol 24, 41–54 (2022). https://doi.org/10.1007/s11940-022-00707-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11940-022-00707-6

Keywords

Search

Navigation