Stroke in Neonates and Children

Miya E. Bernson-Leung; Michael J. Rivkin

doi:10.1542/pir.2016-0002

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Miya E. Bernson-Leung, MD*,^§
Michael J. Rivkin, MD*,^†,^‡,^§

Departments of ^*Neurology,
^†Radiology, and
^‡Psychiatry, Boston Children’s Hospital, Boston, MA
^§Department of Neurology, Harvard Medical School, Boston, MA

AUTHOR DISCLOSURE
Drs Bernson-Leung and Rivkin have disclosed no financial relationships relevant to this article. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device.

Education Gaps

Pediatricians should be aware of the appropriate initial evaluation of suspected stroke in children to combat documented delays in diagnosis of greater than 24 hours. (1)
Pediatricians should be aware of primary and secondary prevention measures for stroke in at-risk populations, such as transcranial Doppler ultrasonography screening for children with sickle cell disease.
Pediatricians must recognize the clinical findings associated with childhood stroke, including ischemic and hemorrhagic stroke, understand the prognosis for each type of stroke, and delineate optimal ongoing management and rehabilitation.

Objectives

After completing this article, readers should be able to:

Describe the pathophysiology of stroke in infants, children, and adolescents.
Recognize the clinical findings associated with childhood stroke and with arteriovenous malformations and other cerebrovascular abnormalities predisposing to childhood stroke.
Delineate the appropriate initial evaluation of suspected stroke in children.

Introduction

Stroke in children is surprisingly common, affecting 1 in 1,600 to 4,000 neonates at birth (2)(3) and 2.3 to 13 per 100,000 older children per year. (4)(5)(6) Strokes can occur in seemingly healthy infants, children, and adolescents. Despite the plasticity of the developing brain, stroke in children carries substantial morbidity. Early recognition of childhood stroke by pediatric clinicians is crucial for the rapid implementation of targeted and neuroprotective therapies. Clinicians should be familiar with risk factors for pediatric stroke and appropriate prevention strategies. Finally, pediatricians are key members of an integrated, multidisciplinary approach to stroke treatment and rehabilitation.

This review begins with a discussion of stroke in children older than 28 days, followed by a discussion of perinatal stroke (before 28 days of age) because strokes in these 2 age groups have …