deVeber G, Roach E S, Riela A R, Wiznitzer M
Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.
Semin Pediatr Neurol. 2000 Dec;7(4):309-17. doi: 10.1053/spen.2000.20074.
Childhood stoke is increasingly recognized, but studies remain largely descriptive. Important differences from adult stroke include the following: (1) frequently delayed or missed diagnosis, (2) heterogenous and overlapping risk factors, and (3) developmental differences in the cerebrovascular, neurologic, and coagulation systems. These aspects limit the extrapolation of the results of adult stroke research and present challenges in caring for children with stroke. The incidence of childhood ischemic stroke exceeds 3.3 in 100,000 children per year, more than double the estimates from past decades. The increased incidence reflects, in part, increased survival in previously fatal conditions predisposing to stroke, including congenital heart disease, sickle cell anemia, and leukemia. Risk factors for stroke are recognized in more than 75% of children. Common risk factors include congenital heart disease and sickle cell disease. Progressive arteriopathies, including vasculitis and moyamoya syndrome, are rare in children with stroke; however, transient arteriopathies including post-varicella angiopathy are increasingly recognized. Prothrombotic abnormalities are frequently present but of unclear significance. Adverse outcomes after childhood stroke, including death in 10%, recurrence in 20%, and neurologic deficits in two thirds of survivors could be reduced with available stroke treatments. Aggressive prehospital emergency care and transfer could improve access to hyperacute stroke therapies including tPA. Currently, the diagnosis is delayed by more than 24 hours from onset in most children. As in adults, tPA will likely produce unacceptable rates of intracerebral hemmorrhage unless given within 3 hours of stroke symptom onset. The appropriate choices for in hospital treatment and secondary preventative strategies, including aspirin and anticoagulants, are controversial. Empiric recommendations are published; however, age-appropriate clinical trials are urgently needed. The large multinational networks of investigators necessary for designing and conducting these future trials are now being formed.
儿童中风越来越受到关注，但相关研究大多仍停留在描述阶段。儿童中风与成人中风的重要差异包括：（1）诊断常常延迟或漏诊；（2）危险因素具有异质性且相互重叠；（3）脑血管、神经和凝血系统存在发育差异。这些因素限制了成人中风研究结果的外推，给儿童中风的护理带来了挑战。儿童缺血性中风的发病率超过每年每10万名儿童中有3.3例，比过去几十年的估计值增加了一倍多。发病率的上升部分反映了先前易引发中风的致命疾病（如先天性心脏病、镰状细胞贫血和白血病）患者存活率的提高。超过75%的儿童中风患者可识别出危险因素。常见的危险因素包括先天性心脏病和镰状细胞病。进展性动脉病变，如血管炎和烟雾病综合征，在儿童中风患者中较为罕见；然而，包括水痘后血管病变在内的短暂性动脉病变越来越受到关注。血栓前状态异常经常出现，但意义尚不明确。现有中风治疗方法可降低儿童中风后的不良后果，包括10%的死亡率、20%的复发率以及三分之二幸存者出现神经功能缺损的情况。积极的院前急救和转运可以改善超急性中风治疗（包括tPA）的可及性。目前，大多数儿童从发病到诊断的延迟超过24小时。与成人一样，除非在中风症状发作后3小时内给药，tPA可能会导致不可接受的脑出血发生率。住院治疗和二级预防策略（包括阿司匹林和抗凝剂）的合适选择存在争议。已有经验性建议发表；然而，迫切需要开展适合不同年龄段的临床试验。目前正在组建设计和开展这些未来试验所需的大型跨国研究网络。
