deVeber Gabrielle
Children's Stroke Program, Department of Pediatrics, University of Toronto, Ontario, Canada.
Semin Thromb Hemost. 2003 Dec;29(6):567-73. doi: 10.1055/s-2004-815624.
Stroke in children is increasingly recognized. The incidence exceeds 8 per 100,000 per year. Important differences in stroke in newborns and children compared with adults, as well as a paucity of clinical trials, create challenges in the diagnosis and management of pediatric arterial ischemic stroke (AIS). The neurological presentation of AIS can be subtle. Radiographic diagnosis of acute AIS is also challenging because CT scan may be normal early on. Risk factors include vascular, intravascular, and embolic disorders; frequently, there are multiple risk factors in a given child, necessitating thorough investigations. More than 50% have a vasculopathy including postvaricella angiopathy, dissection, moyamoya, or vasculitis. Intravascular mechanisms are frequently present, including dehydration. Hematological or prothrombotic conditions are also associated with AIS in children, and include sickle cell disease and prothrombotic disorders. The latter have been identified in from one third to one half of children with AIS, are usually acquired, and frequently act in concert with other risk factors for stroke. The most common embolic source is congenital heart disease, which is present in 25% of children with AIS. Outcomes include death in 6% and neurological deficits in two thirds of children. Given that no clinical trials have been completed in pediatric stroke to date, treatment is empiric. Initial neuroprotective strategies aim to reduce the size of the infarct. For older children antithrombotic agents (antiplatelet drugs and anticoagulants) are given to reduce the 20 to 30% risk of recurrence. There are coordinated research efforts currently being initiated, which over the next decade will result in clinical trials in this understudied condition.
儿童中风越来越受到关注。其发病率每年超过十万分之八。新生儿和儿童中风与成人中风存在重要差异，且临床试验较少，这给小儿动脉缺血性中风（AIS）的诊断和管理带来了挑战。AIS的神经系统表现可能不明显。急性AIS的影像学诊断也具有挑战性，因为早期CT扫描可能正常。风险因素包括血管、血管内和栓塞性疾病；通常，特定儿童存在多种风险因素，需要进行全面检查。超过50%的患儿患有血管病变，包括水痘后血管病变、夹层、烟雾病或血管炎。血管内机制也经常存在，包括脱水。血液学或血栓前状态也与儿童AIS相关，包括镰状细胞病和血栓前疾病。后者在三分之一至一半的AIS患儿中被发现，通常是后天获得的，并且经常与其他中风风险因素共同作用。最常见的栓子来源是先天性心脏病，在25%的AIS患儿中存在。预后包括6%的患儿死亡，三分之二的患儿有神经功能缺损。鉴于迄今为止小儿中风尚未完成临床试验，治疗是经验性的。初始神经保护策略旨在缩小梗死灶大小。对于大龄儿童，给予抗血栓药物（抗血小板药物和抗凝剂）以降低20%至30%的复发风险。目前正在启动协调一致的研究工作，在未来十年内将针对这种研究不足的疾病开展临床试验。
