Kossorotoff M, Meyer P, Lebas A, Chabrier S
Service de neurologie pédiatrique, hôpital Necker-Enfants-Malades, 149 rue de Sèvres, Paris cedex 15, France.
Rev Neurol (Paris). 2012 Jun;168(6-7):527-32. doi: 10.1016/j.neurol.2010.11.005. Epub 2012 May 10.
Stroke in children is not rare. Although there are no randomized trials on childhood stroke, except in sickle cell disease patients, several international guidelines have described quality criteria for stroke management in children. Age-adapted management is required, involving collaboration with a pediatric neurologist and hospitalization in a pediatric intensive care or continuous care unit. All symptomatic treatments used in adults can be recommended in children, including homeostasis assessment and maintenance or blood exchange in sickle cell disease patients. Specific treatments such as thrombolysis or mechanical thrombectomy are not recommended in children, except in the framework of clinical trials, but can be beneficial in adolescents. Multidisciplinary decision-making should be the rule in such situations. Adolescents may be managed in adult stroke units. Indications for surgery in children are adapted from adult guidelines. Appropriate management of cerebral venous thrombosis in children is similar to that in adults. The best management possible can be achieved through a multidisciplinary dialogue between the pediatric neurologist and the adult intensivist or neurologist.
儿童中风并不罕见。尽管除镰状细胞病患者外，尚无关于儿童中风的随机试验，但一些国际指南已描述了儿童中风管理的质量标准。需要进行适合年龄的管理，包括与儿科神经科医生合作，并在儿科重症监护室或持续护理病房住院治疗。成人使用的所有对症治疗方法均可推荐用于儿童，包括镰状细胞病患者的内环境稳定评估与维持或换血治疗。除临床试验外，不建议在儿童中使用溶栓或机械取栓等特殊治疗方法，但对青少年可能有益。在这种情况下，多学科决策应成为准则。青少年可在成人中风单元接受治疗。儿童手术适应症是根据成人指南调整的。儿童脑静脉血栓形成的适当管理与成人相似。通过儿科神经科医生与成人重症监护医生或神经科医生之间的多学科对话，可以实现尽可能最佳的管理。
