Steinlin Maja, Mackay Mark T
Paediatric Neurology, University Children's Hospital and Neurocentre, Inselspital Bern, Bern, 3010, Switzerland,
Curr Treat Options Neurol. 2015 May;17(5):349. doi: 10.1007/s11940-015-0349-2.
Children who present with acute neurological symptoms suggestive of a stroke need immediate clinical assessment and urgent neuroimaging to confirm diagnosis. Magnetic resonance imaging (MRI) is the investigation of first choice due to limited sensitivity of computed tomography (CT) for detection of ischaemia. Acute monitoring should include monitoring of blood pressure and body temperature, and neurological observations. Surveillance in a paediatric high dependency or intensive care unit and neurosurgical consultation are mandatory in children with large infarcts at risk of developing malignant oedema or haemorrhagic transformation. Thrombolysis and/or endovascular treatment, whilst not currently approved for use in children, may be considered when stroke diagnosis is confirmed within 4.5 to 6 h, provided there are no contraindications on standard adult criteria. Standard treatment consists of aspirin, but anticoagulation therapy is frequently prescribed in stroke due to cardiac disease and extracranial dissection. Steroids and immunosuppression have a definite place in children with proven vasculitis, but their role in focal arteriopathies is less clear. Decompressive craniotomy should be considered in children with deteriorating consciousness or signs of raised intracranial pressure.
出现提示中风的急性神经症状的儿童需要立即进行临床评估和紧急神经影像学检查以确诊。由于计算机断层扫描（CT）检测缺血的敏感性有限，磁共振成像（MRI）是首选的检查方法。急性监测应包括血压和体温监测以及神经学观察。对于有发生恶性水肿或出血性转化风险的大面积梗死患儿，必须在儿科高依赖或重症监护病房进行监测并咨询神经外科。溶栓和/或血管内治疗目前虽未被批准用于儿童，但在中风诊断于4.5至6小时内得到确认且无标准成人标准的禁忌症时可考虑使用。标准治疗包括阿司匹林，但由于心脏病和颅外夹层导致的中风常采用抗凝治疗。类固醇和免疫抑制在已证实患有血管炎的儿童中具有明确作用，但其在局灶性动脉病变中的作用尚不清楚。对于意识恶化或有颅内压升高迹象的儿童，应考虑进行减压开颅手术。
