This review and case series highlights the diagnostic challenges of pediatric ischemic stroke and the potential life-saving role of decompressive craniectomy when recanalization therapies fail or are complicated by malignant edema.
Case series supports aggressive intervention in select adolescent stroke; leaves open pediatric guideline development without prospective data.
Stroke is a rare condition in childhood with an estimated incidence of between 1.3-13/100.000 patients. Clinical manifestation and risk factors for paediatric stroke are different from those of adults. The uncommon incidence, age-associated difference and plethora of clinical symptoms make the diagnosis of such strokes extremely difficult and often delayed. The history and clinical examination should point to diseases or predisposing factors. Neuroimaging (DWI MR) is the golden standard for diagnosis of paediatric stroke and other investigations can be considered according to the clinical condition. Despite advances in paediatric stroke research and clinical care, questions remain unanswered regarding acute treatment, secondary prevention and rehabilitation. The treatment recommendations are mainly extrapolated from studies on adult populations. In the review authors summarized the clinical characteristics and diagnostic steps for stroke in children/adolescents based on the most recent international guidelines and practical directions for recognising and managing the child/adolescent with stroke in paediatric emergency. In the two case reports, we describe the clinical course in both stroke patients.
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Klučka et al. (2016) conducted a review in Acute ischemic stroke (n=2). Mechanical thrombectomy and decompressive craniectomy was evaluated.
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