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The
most common clinical presentation of clinical stroke in childhood is acute
hemiparesis.
- Focal neurologic deficits, usually hemiplegia and seizures in ischemic
stroke
- Headache and vomiting in hemorrhagic stroke
- Headache and decreased level of consciousness in children with cerebral
venous thrombosis
Focal signs may be absent in neonates or young infants
and seizures may be the only signs of stroke in this group.
The
following is a summary of information provided at the CHASA medical
conference, 2002 by John K. Lynch, DO, NINDS.
There are no published consensus guidelines
on the evaluation of stroke in children, but several systematic approaches
have been recommended. The evaluation should include:
-
Questions about any history of head
trauma, neck trauma, recent infection, illness, unexplained fever or
malaise, drug ingestion, developmental delay, family history of
bleeding problems, and associated headache
-
Careful family history, with special
attention to premature vascular disease, hematologic disease, mental
retardation
-
Physical exam including head
circumference in children, skin abnormalities, cardiac evaluation and
carotid artery exam
-
MRI and MRA (CT if MR unavailable)
If
the MRI and MRA reveal an infarct, with vascular distribution, then
consider the following diagnostic tests:
-
Echocardiogram, EKG, holter monitor
-
Blood studies including CBC, ESR, Iron,
folate, red cell folate, hemoglobin electrophoresis, Protein S,
Protein C, Antithrombin III, Factor V Leiden, Heparin cofactor II,
plasminogen, Factor VIII, Factor XII, anticardiolipin antibodies,
lupus anticoagulant, prothrombin mutation, homocysteine, lipoprotein
a, fasting cholesterol, infection screen, serum and CSF antibodies to
varicella
-
Lumbar puncture
-
Transcranial Doppler with bubble study
-
X-ray cervical spine (posterior
infarctions)
If
the MRI and MRA reveal an infarct, with non-vascular distribution,
then consider the following diagnostic tests:
If
the MRI and MRA reveal a hemorrhage, then consider the following
diagnostic tests:
-
Coagulation studies
-
Conventional Angiography
If
the MRA is normal, then consider the following diagnostic tests:
Journal
Articles
Childhood Strokes: Evaluation And Management,
Nov. 1998. Harry S. Abram, M.D., a pediatric Neurologist on faculty at
Mayo Graduate School of Medicine
Diagnostic
pitfalls in paediatric ischaemic stroke. Dec. 2006. The Netherlands.
Stroke
in Childhood: Clinical guidelines for diagnosis, management and
rehabilitation. Prepared by the Paediatric Stroke Working Group, Nov.
2004. Clinical Effectiveness and Evaluation Unit of the Royal College of
Physicians.
Emergency
department presentation of pediatric stroke.
Oct. 2003. Los Angeles, CA. Calder, Kokorowski, Tran, Henderson. It is
important for the emergency physician to recognize acute neurologic events
in pediatric patients to minimize complications.
Diagnosis
of Stroke
Information
about the different tests used in diagnosing a stroke.
MRI Imaging Answers
questions about the MRI test
General
movements detect early signs of hemiplegia in term infants with neonatal
cerebral infarction. April 2003. Italy.
Guzzetta.
Neonatal
cerebral infarction diagnosed by diffusion-weighted MRI:
pseudonormalization occurs early April 2002
Magnetic
resonance imaging in pediatric stroke Feb. 2002. Houston. Hunter.
Magnetic resonance imaging provides a noninvasive method of investigating
childhood stroke, aiding in both better diagnosis and management of this
problem.
MRI
and clinical characteristics of children with hemiplegic cerebral palsy
Oct. 1999
What
is a Stroke?
Information
on the different types of strokes, again from an adult perspective.
Etiology
of stroke in children
2000
Specifics
in pediatric arterial cerebral infarctions
2001
The
Whole Brain Atlas
Contains illustration of the brain and the different sections and their
function. Please remember that they are referring to stroke in an adult
whose brain is already organized and the results of a stroke are very
different in a young child's pliable brain.
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