Role of Imaging in Acute Ischemic Stroke

Rapid multimodal imaging is essential in the workup and management of acute ischemic stroke. Early parenchymal findings on noncontrast computed tomography or standard magnetic resonance imaging are used to triage patients for intravenous thrombolysis and to provide insight on prognosis. In the wake of recent endovascular stroke trials, advanced techniques including perfusion imaging and noninvasive vascular imaging are becoming important tools to guide potential endovascular treatment or expand therapy windows. Advanced imaging is also important in pediatric ischemic stroke which requires a slightly different workflow and treatment approach. Here, we will discuss key imaging findings in acute ischemic stroke, as well as the present and future of neuroimaging in light of recent and ongoing clinical trials

Recent Advances in Childhood Arterial Ischemic Stroke

Although many underlying diseases have been reported in the setting of childhood arterial ischemic stroke, emerging research demonstrates that non-atherosclerotic intracerebral arteriopathies in otherwise healthy children are prevalent. Minor infections may play a role in arteriopathies that have no other apparent underlying cause. Although stroke in childhood differs in many aspects from adult stroke, few systematic studies specific to pediatrics are available to inform stroke management. Treatment trials of pediatric stroke are required to determine the best strategies for acute treatment and secondary stroke prevention. The high cost of pediatric stroke to children, families, and society demands further study of its risk factors, management, and outcomes. This review focuses on the recent findings in childhood arterial ischemic stroke

Harnessing Neuroimaging Capability in Pediatric Stroke: Proceedings of the Stroke Imaging Laboratory for Children Workshop.

On June 5, 2015 the International Pediatric Stroke Study and the Stroke Imaging Laboratory for Children cohosted a unique workshop focused on developing neuroimaging research in pediatric stroke. Pediatric neurologists, neuroradiologists, interventional neuroradiologists, physicists, nurse practitioners, neuropsychologists, and imaging research scientists from around the world attended this one-day meeting. Our objectives were to (1) establish a group of experts to collaborate in advancing pediatric neuroimaging for stroke, (2) develop consensus clinical and research magnetic resonance imaging protocols for pediatric stroke patients, and (3) develop imaging-based research strategies in pediatric ischemic stroke. This article provides a summary of the meeting proceedings focusing on identified challenges and solutions and outcomes from the meeting. Further details on the workshop contents and outcomes are provided in three additional articles in the current issue of Pediatric Neurology

Current Proceedings of Childhood Stroke

Stroke is a sudden onset neurological deficit due to a cerebrovascular event. In children, the recognition of stroke is often delayed due to the low incidence of stroke and the lack of specific assessment measures to this entity. The causes of pediatric stroke are significantly different from that of adult stroke. The lack of safety and efficiency data in the treatment is the challenge while facing children with stroke. Nearly half of survivors of pediatric stroke may have neurologic deficits affecting functional status and quality of life. They may cause a substantial burden on health care resources. Hence, an accurate history, including onset and duration of symptoms, risk factors, and a complete investigation, including hematologic, neuroimaging, and metabolic studies is the key to make a corrective diagnosis. A prompt and optimal treatment without delay may minimize the damage to the brain

Pediatric Stroke Presenting as a Seizure.

Background. Childhood arterial ischemic stroke (AIS) is rare and may be difficult to diagnose. Management of acute stroke in any age group is time sensitive, so awareness of the manifestations and appropriate diagnostic procedures for pediatric AIS is vital to establishing care. We present a pediatric case of arterial ischemic stroke that presented to the emergency department (ED) after two seizures. Case Report. A five-year-old female with an existing seizure disorder presented to a pediatric ED after having two seizures. Postictal upon arrival, she underwent a computed tomography (CT) scan of her head. Family reported that she had complained of a severe headache and vomited; her seizures were described as different from those she had experienced in the past. Loss of grey white matter differentiation on the CT warranted magnetic resonance imaging (MRI), which demonstrated a right-sided stroke. After a complicated course in the hospital, the patient was discharged to a rehabilitation hospital. Why Should an Emergency Physician Be Aware of This? It is important that emergency physicians recognize that a seizure may be the initial symptom of a pediatric stroke regardless of an established seizure history. Pediatric seizures are relatively common; however consideration of the diagnosis of pediatric stroke may prevent unnecessary delays in treatment

Pediatric Stroke in the Southern Region of Iran: A Retrospective Prognostic Cohort Study

  Objective Childhood stroke is linked to high personal costs for affected children and their families since more than half of the survivors are impaired fora long time, hampering their normal development and lifestyle. Thus,the present study aimed to evaluate the neurological developmental outcomes of children admitted to Namazi hospital, Shiraz, Iran, for ischemic and hemorrhagic stroke with a five-year follow-up. Ma a retrospective cohort study on children admitted to Namazi Hospital due to ischemic and hemorrhagic stroke during the past three years (2012-2015). The information was collected by reviewing the medical records and clinically visiting the patients on follow-up. The SPSS 21.0 software was used for statistical analysis. Materials & Method This is a retrospective cohort study on children admitted to Namazi hospital due to ischemic and hemorrhagic stroke during past three years (2012-2015). The information was collected by reviewing the medical records and clinically visiting the patients at the time of follow up. The SPSS 21.0 software was used for statistical analysis Settings. Results The patients’ mean age at the time of stroke was 6.87 ± 4.60 years. The mean follow-up period was 3.5 ± 1.64 years. 53.1% of the children (N=17) were diagnosed with hemorrhagic stroke, and 46.9% (N=15) with ischemic stroke. The most frequent symptoms first presented by the study population were a decrease in the level of consciousness (LOC) (40.6%), headaches (37.5 %), and hand/arm/leg weakness (34.4%), respectively. The number of patients in the poor and severe outcome group was 73.3% in the ischemic and 52.9% in the hemorrhagic group. Conclusion Hemorrhagic stroke was slightly more frequent than ischemic stroke, and stroke was more frequent in boys. A decrease in LOC and headaches were the most common symptoms upon admission. The left sensorimotor area was the most involved in both ischemic and hemorrhagic groups. In addition, trauma was the most common cause of stroke in this study population. &nbsp

Pediatric Stroke: A Review

Stroke is relatively rare in children, but can lead to significant morbidity and mortality. Understanding that children with strokes present differently than adults and often present with unique risk factors will optimize outcomes in children. Despite an increased incidence of pediatric stroke, there is often a delay in diagnosis, and cases may still remain under- or misdiagnosed. Clinical presentation will vary based on the child's age, and children will have risk factors for stroke that are less common than in adults. Management strategies in children are extrapolated primarily from adult studies, but with different considerations regarding short-term anticoagulation and guarded recommendations regarding thrombolytics. Although most recommendations for management are extrapolated from adult populations, they still remain useful, in conjunction with pediatric-specific considerations