Acute Ischemic Stroke in Children

  • Soonhak KwonEmail author


Stroke can occur at any time during the life, but causes, clinical features, and other clinical perspectives differ depending on the patient’s age. In this chapter, I try to focus on risk factors, clinical manifestations, diagnosis, management, and other important issues in childhood arterial ischemic stroke.


Sickle Cell Anemia Fabry Disease Moyamoya Disease Arterial Dissection Arterial Ischemic Stroke 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Amlie-Lefond C, Bernard TJ, Sebire G, et al. Predictors of cerebral arteriopathy in children with arterial ischemic stroke: results of the International Pediatric Stroke Study. Circulation. 2009;119(10):1417–23.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Incecik F, Ozlem Herguner M, Altunbasak S. Risk factors and treatment outcomes for children with arterial ischemic stroke. J Clin Neurosci: Off J Neurosurg Soc Australas. 2010;17(8):1000–2.CrossRefGoogle Scholar
  3. 3.
    Lenicek Krleza J, Ethuranovic V, Bronic A, et al. Multiple presence of prothrombotic risk factors in Croatian children with arterial ischemic stroke and transient ischemic attack. Croat Med J. 2013;54(4):346–54.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Poisson SN, Schardt TQ, Dingman A, et al. Etiology and treatment of arterial ischemic stroke in children and young adults. Curr Treat Options Neurol. 2014;16(10):315.CrossRefPubMedGoogle Scholar
  5. 5.
    Mallick AA, Ganesan V, Kirkham FJ, et al. Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study. Lancet Neurol. 2014;13(1):35–43.CrossRefPubMedGoogle Scholar
  6. 6.
    Laugesaar R, Kolk A, Uustalu U, et al. Epidemiology of childhood stroke in Estonia. Pediatr Neurol. 2010;42(2):93–100.CrossRefPubMedGoogle Scholar
  7. 7.
    Agrawal N, Johnston SC, Wu YW, et al. Imaging data reveal a higher pediatric stroke incidence than prior US estimates. Stroke; J Cereb Circ. 2009;40(11):3415–21.CrossRefGoogle Scholar
  8. 8.
    Lynch JK, Nelson KB. Epidemiology of perinatal stroke. Curr Opin Pediatr. 2001;13(6):499–505.CrossRefPubMedGoogle Scholar
  9. 9.
    Masri A, Al-Ammouri I. Clinical presentation, etiology, and outcome of stroke in children: a hospital-based study. Brain Dev. 2015;38(11):204–8.Google Scholar
  10. 10.
    Bernard TJ, Goldenberg NA. Pediatric arterial ischemic stroke. Pediatr Clin N Am. 2008;55(2):323–38.CrossRefGoogle Scholar
  11. 11.
    Fullerton HJ, Wu YW, Sidney S, et al. Risk of recurrent childhood arterial ischemic stroke in a population-based cohort: the importance of cerebrovascular imaging. Pediatrics. 2007;119(3):495–501.CrossRefPubMedGoogle Scholar
  12. 12.
    Ganesan V, Prengler M, McShane MA, et al. Investigation of risk factors in children with arterial ischemic stroke. Ann Neurol. 2003;53(2):167–73.CrossRefPubMedGoogle Scholar
  13. 13.
    DeVeber G. Risk factors for childhood stroke: little folks have different strokes! Ann Neurol. 2003;53(2):149–50.CrossRefPubMedGoogle Scholar
  14. 14.
    Mackay MT, Wiznitzer M, Benedict SL, et al. Arterial ischemic stroke risk factors: the International Pediatric Stroke Study. Ann Neurol. 2011;69(1):130–40.CrossRefPubMedGoogle Scholar
  15. 15.
    Dowling MM, Ikemba CM. Intracardiac shunting and stroke in children: a systematic review. J Child Neurol. 2011;26(1):72–82.CrossRefPubMedGoogle Scholar
  16. 16.
    Wu LA, Malouf JF, Dearani JA, et al. Patent foramen ovale in cryptogenic stroke: current understanding and management options. Arch Intern Med. 2004;164(9):950–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Dowling MM, Hynan LS, Lo W, et al. International Paediatric Stroke Study: stroke associated with cardiac disorders. Int J Stroke: Off J Int Stroke Soc. 2013;8(Suppl A100):39–44.CrossRefGoogle Scholar
  18. 18.
    Sanchetee P. Stroke and central nervous system infections. J Indian Med Assoc. 2009;107(6):372–7.PubMedGoogle Scholar
  19. 19.
    Hills NK, Johnston SC, Sidney S, et al. Recent trauma and acute infection as risk factors for childhood arterial ischemic stroke. Ann Neurol. 2012;72(6):850–8.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Hausler MG, Ramaekers VT, Reul J, et al. Early and late onset manifestations of cerebral vasculitis related to varicella zoster. Neuropediatrics. 1998;29(4):202–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Hayman M, Hendson G, Poskitt KJ, et al. Postvaricella angiopathy: report of a case with pathologic correlation. Pediatr Neurol. 2001;24(5):387–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Kong M, Jiang L, Hu J, et al. Clinical characteristics of mycoplasma pneumoniae-associated ischemic stroke in children, and a literature review. Zhongguo Dang Dai Er Ke Za Zhi: Chin J Contemp Pediatr. 2012;14(11):823–6.Google Scholar
  23. 23.
    Kutlesa M, Tesovic G, Knezovic I, et al. Ischemic stroke associated with adenoviral infection in a 4-year-old boy. Wien Klin Wochenschr. 2009;121(23–24):776–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Sepelyak K, Gailloud P, Jordan LC. Athletics, minor trauma, and pediatric arterial ischemic stroke. Eur J Pediatr. 2010;169(5):557–62.CrossRefPubMedGoogle Scholar
  25. 25.
    Fullerton HJ, Johnston SC, Smith WS. Arterial dissection and stroke in children. Neurology. 2001;57(7):1155–60.CrossRefPubMedGoogle Scholar
  26. 26.
    Fujimura M, Sonobe S, Nishijima Y, et al. Genetics and biomarkers of Moyamoya disease: significance of RNF213 as a susceptibility gene. J Stroke. 2014;16(2):65–72.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Jang MA, Shin S, Yoon JH, et al. Frequency of the moyamoya-related RNF213 p.Arg4810Lys variant in 1,516 Korean individuals. BMC Med Genet. 2015;16(1):109.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Scott RM, Smith ER. Moyamoya disease and moyamoya syndrome. N Engl J Med. 2009;360(12):1226–37.CrossRefPubMedGoogle Scholar
  29. 29.
    deVeber G, Roach ES, Riela AR, et al. Stroke in children: recognition, treatment, and future directions. Semin Pediatr Neurol. 2000;7(4):309–17.CrossRefPubMedGoogle Scholar
  30. 30.
    Numis AL, Fox CK. Arterial ischemic stroke in children: risk factors and etiologies. Curr Neurol Neurosci Rep. 2014;14(1):422.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Lyle CA, Bernard TJ, Goldenberg NA. Childhood arterial ischemic stroke: a review of etiologies, antithrombotic treatments, prognostic factors, and priorities for future research. Semin Thromb Hemost. 2011;37(7):786–93.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Adams RJ, Nichols FT, Figueroa R, et al. Transcranial doppler correlation with cerebral angiography in sickle cell disease. Stroke; J Cereb Circ. 1992;23(8):1073–7.CrossRefGoogle Scholar
  33. 33.
    Lee MT, Piomelli S, Granger S, et al. Stroke prevention trial in sickle cell anemia (STOP): extended follow-up and final results. Blood. 2006;108(3):847–52.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Kassim AA, Galadanci NA, Pruthi S, et al. How I treat and manage strokes in sickle cell disease. Blood. 2015;125(22):3401–10.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Griessenauer CJ, Fleming JB, Richards BF, et al. Timing and mechanism of ischemic stroke due to extracranial blunt traumatic cerebrovascular injury. J Neurosurg. 2013;118(2):397–404.CrossRefPubMedGoogle Scholar
  36. 36.
    Westover AN, McBride S, Haley RW. Stroke in young adults who abuse amphetamines or cocaine: a population-based study of hospitalized patients. Arch Gen Psychiatry. 2007;64(4):495–502.CrossRefPubMedGoogle Scholar
  37. 37.
    Bowers DC, Liu Y, Leisenring W, et al. Late-occurring stroke among long-term survivors of childhood leukemia and brain tumors: a report from the Childhood Cancer Survivor Study. J Clin Oncol Off J Am Soc Clin Oncol. 2006;24(33):5277–82.CrossRefGoogle Scholar
  38. 38.
    Mueller S, Fullerton HJ, Stratton K, et al. Radiation, atherosclerotic risk factors, and stroke risk in survivors of pediatric cancer: a report from the Childhood Cancer Survivor Study. Int J Radiat Oncol Biol Phys. 2013;86(4):649–55.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Mueller S, Sear K, Hills NK, et al. Risk of first and recurrent stroke in childhood cancer survivors treated with cranial and cervical radiation therapy. Int J Radiat Oncol Biol Phys. 2013;86(4):643–8.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Lopez-Vicente M, Ortega-Gutierrez S, Amlie-Lefond C, et al. Diagnosis and management of pediatric arterial ischemic stroke. J Stroke Cerebrovasc Dis: Off J Natl Stroke Assoc. 2010;19(3):175–83.CrossRefGoogle Scholar
  41. 41.
    Singh RK, Zecavati N, Singh J, et al. Seizures in acute childhood stroke. J Pediatr. 2012;160(2):291–6.CrossRefPubMedGoogle Scholar
  42. 42.
    Ciccone S, Cappella M, Borgna-Pignatti C. Ischemic stroke in infants and children: practical management in emergency. Stroke Res Treat. 2011;2011:736965.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Brott TG, Halperin JL, Abbara S, et al. Guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Developed in collaboration with the American Academy of Neurology and Society of Cardiovascular Computed Tomography. Catheter Cardiovasc Interv: Off J Soc Card Angiography Interv. 2013;81(1):E76–123.CrossRefGoogle Scholar
  44. 44.
    Amlie-Lefond C, deVeber G, Chan AK, et al. Use of alteplase in childhood arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol. 2009;8(6):530–6.CrossRefPubMedGoogle Scholar
  45. 45.
    Amlie-Lefond C, Fullerton HJ. Thrombolytics for hyperacute stroke in children. Pediatr Hematol Oncol. 2009;26(3):103–7.CrossRefPubMedGoogle Scholar
  46. 46.
    Ellis JA, Youngerman BE, Higashida RT, et al. Endovascular treatment strategies for acute ischemic stroke. Int J Stroke: Off J Int Stroke Soc. 2011;6(6):511–22.CrossRefGoogle Scholar
  47. 47.
    Ellis MJ, Amlie-Lefond C, Orbach DB. Endovascular therapy in children with acute ischemic stroke: review and recommendations. Neurology. 2012;79(13 Suppl 1):S158–64.CrossRefPubMedGoogle Scholar
  48. 48.
    Monagle P, Chan A, Massicotte P, et al. Antithrombotic therapy in children: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004;126(3 Suppl):645S–87S.CrossRefPubMedGoogle Scholar
  49. 49.
    Lansberg MG, O’Donnell MJ, Khatri P, et al. Antithrombotic and thrombolytic therapy for ischemic stroke: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e601S–36S.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Adams RJ, McKie VC, Hsu L, et al. Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med. 1998;339(1):5–11.CrossRefPubMedGoogle Scholar
  51. 51.
    Gordon AM, Hung YC, Brandao M, et al. Bimanual training and constraint-induced movement therapy in children with hemiplegic cerebral palsy: a randomized trial. Neurorehabil Neural Repair. 2011;25(8):692–702.CrossRefPubMedGoogle Scholar
  52. 52.
    Kirton A, Chen R, Friefeld S, et al. Contralesional repetitive transcranial magnetic stimulation for chronic hemiparesis in subcortical paediatric stroke: a randomised trial. Lancet Neurol. 2008;7(6):507–13.CrossRefPubMedGoogle Scholar
  53. 53.
    Yang JF, Livingstone D, Brunton K, et al. Training to enhance walking in children with cerebral palsy: are we missing the window of opportunity? Semin Pediatr Neurol. 2013;20(2):106–15.CrossRefPubMedGoogle Scholar
  54. 54.
    Chung MG, Lo WD. Noninvasive brain stimulation: the potential for use in the rehabilitation of pediatric acquired brain injury. Arch Phys Med Rehabil. 2015;96(4 Suppl):S129–37.CrossRefPubMedGoogle Scholar
  55. 55.
    Goldenberg NA, Bernard TJ, Fullerton HJ, et al. Antithrombotic treatments, outcomes, and prognostic factors in acute childhood-onset arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol. 2009;8(12):1120–7.CrossRefPubMedGoogle Scholar
  56. 56.
    Steinlin M, Roellin K, Schroth G. Long-term follow-up after stroke in childhood. Eur J Pediatr. 2004;163(4–5):245–50.CrossRefPubMedGoogle Scholar
  57. 57.
    Ganesan V, Prengler M, Wade A, et al. Clinical and radiological recurrence after childhood arterial ischemic stroke. Circulation. 2006;114(20):2170–7.CrossRefPubMedGoogle Scholar
  58. 58.
    Lanthier S, Carmant L, David M, et al. Stroke in children: the coexistence of multiple risk factors predicts poor outcome. Neurology. 2000;54(2):371–8.CrossRefPubMedGoogle Scholar
  59. 59.
    Strater R, Becker S, von Eckardstein A, et al. Prospective assessment of risk factors for recurrent stroke during childhood – a 5-year follow-up study. Lancet. 2002;360(9345):1540–5.CrossRefPubMedGoogle Scholar
  60. 60.
    Cnossen MH, Aarsen FK, Akker S, et al. Paediatric arterial ischaemic stroke: functional outcome and risk factors. Dev Med Child Neurol. 2010;52(4):394–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Singapore 2017

Authors and Affiliations

  1. 1.Kyungpook National University Children’s Hospital and School of MedicineDaeguSouth Korea

Personalised recommendations