Children who present with acute neurological symptoms suggestive of a
stroke need immediate clinical assessment and urgent neuroimaging to confirm diagnosis. Magnetic resonance imaging (MRI) is the investigation of first choice due to limited sensitivity of computed tomography (CT) for detection of ischaemia. Acute monitoring should include monitoring of blood pressure and body temperature, and neurological observations. Surveillance in a paediatric high dependency or intensive care unit and neurosurgical consultation are mandatory in children with large
infarcts at risk of developing malignant oedema or haemorrhagic transformation. Thrombolysis and/or endovascular treatment, whilst not currently approved for use in children, may be considered when
stroke diagnosis is confirmed within 4.5 to 6 h, provided there are no
contraindications on standard adult criteria. Standard treatment consists of
aspirin, but anticoagulation
therapy is frequently prescribed in
stroke due to
cardiac disease and extracranial dissection.
Steroids and immunosuppression have a definite place in children with proven
vasculitis, but their role in focal arteriopathies is less clear.
Decompressive craniotomy should be considered in children with deteriorating consciousness or signs of raised intracranial pressure.