Nowak-Göttl Ulrike, Günther Gudrun, Kurnik Karin, Sträter Ronald, Kirkham Fenella
Department of Haematology/Oncology, University of Münster Münster, Germany.
Semin Thromb Hemost. 2003 Aug;29(4):405-14. doi: 10.1055/s-2003-42590.
Conditions associated with arterial ischemic stroke (AIS) in children include congenital heart malformations, sickle cell disease, and meningitis, although around half of all cases are cryptogenic. Up to 80% of children with ischemic stroke have cerebrovascular disease, and case control studies demonstrate an association of arterial ischemic stroke in children with hereditary prothrombotic risk factors and infections such as Varicella. Conventional risk factors, such as hypertension and dyslipidemia, may also play a role and most children have several potential triggers rather than a single cause. Treatment recommendations are based on small case series or have been adapted from adult stroke studies; there are no evidence-based data on efficacy in children. Low-dose aspirin appears to be relatively safe. Anticoagulation with heparins, for example, low-molecular-weight heparin or warfarin, may be indicated in children with cardioembolic stroke, arterial dissection, or persistent hypercoagulable states, and blood transfusion has a role in patients with sickle cell disease. Tissue plasminogen activator has been used in a few patients within 3 hours of the onset of symptoms. At present, the benefit of treatment has to be weighed against the risk for each patient, but randomized controlled trials for primary prevention, acute treatment, and secondary prevention of pediatric ischemic stroke are urgently needed.
儿童动脉缺血性卒中（AIS）相关的病症包括先天性心脏畸形、镰状细胞病和脑膜炎，不过所有病例中约有一半病因不明。高达80%的缺血性卒中儿童患有脑血管疾病，病例对照研究表明，儿童动脉缺血性卒中与遗传性血栓形成危险因素以及水痘等感染有关。传统危险因素，如高血压和血脂异常，也可能起作用，而且大多数儿童有多种潜在诱因，而非单一病因。治疗建议基于小病例系列研究，或借鉴成人卒中研究；尚无关于儿童疗效的循证数据。低剂量阿司匹林似乎相对安全。对于心源性栓塞性卒中、动脉夹层或持续性高凝状态的儿童，可能需要使用肝素（如低分子量肝素或华法林）进行抗凝治疗，输血在镰状细胞病患者中有用。组织纤溶酶原激活剂已用于少数症状发作3小时内的患者。目前，必须权衡每位患者治疗的益处与风险，但迫切需要针对儿童缺血性卒中的一级预防、急性治疗和二级预防开展随机对照试验。
