Department Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Curr Opin Pediatr. 2010 Feb;22(1):20-7. doi: 10.1097/MOP.0b013e3283350d94.
The past year has marked a period of growing awareness of the need for improved diagnosis and treatment in children with arterial ischemic stroke (AIS) and cerebral sinus venous thrombosis (CSVT). Here we review these conditions, highlighting the importance of the intersection between hematologic abnormalities and pediatric stroke as they impact clinical management.
Recent multicenter cohort studies are beginning to clarify the incidence, risk factors, clinical course and outcomes of AIS and CSVT in children. Key findings include: diagnosis rests on adequate neuroimaging and is often delayed more than 24 h after symptom onset; multiple risk factors and inciting events are often involved; one or more prothrombotic risk factors are common; recurrence is common; and selected groups of patients benefit from anticoagulation, and less frequently, thrombolytic therapies.
Progress in caring for children with AIS and CSVT requires greatly improved awareness of cerebrovascular disease among primary providers, who are most often the first point of contact, more rapid and specific diagnosis using appropriate advanced neuroimaging technologies, comprehensive hematologic evaluation for inherited and acquired thrombophilias, and multidisciplinary approaches to treatment. Additional large cohort studies and clinical trials are greatly needed to further clarify these issues.
目的综述：过去一年，人们越来越意识到需要改善儿童动脉缺血性脑卒中（AIS）和脑静脉窦血栓形成（CSVT）的诊断和治疗。在这里，我们将对这些病症进行综述，强调血液学异常与儿科脑卒中之间的交叉点对临床管理的重要性。
最新发现：最近的多中心队列研究开始阐明儿童 AIS 和 CSVT 的发病率、危险因素、临床过程和结局。主要发现包括：诊断依赖于充分的神经影像学检查，并且通常在症状出现后 24 小时以上才进行；涉及多个危险因素和诱发事件；常见一个或多个血栓形成前危险因素；复发常见；某些患者群体受益于抗凝治疗，较少情况下受益于溶栓治疗。
总结：在照顾 AIS 和 CSVT 患儿方面取得进展，需要初级医疗提供者（通常是第一个接触点）对脑血管疾病有更深入的认识，使用适当的先进神经影像学技术更快速和更准确的诊断，对遗传性和获得性血栓形成倾向进行全面的血液学评估，以及采用多学科方法进行治疗。还需要进行更多的大型队列研究和临床试验来进一步阐明这些问题。
