Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Nat Rev Dis Primers. 2022 Feb 24;8(1):12. doi: 10.1038/s41572-022-00337-x.
Stroke is an important cause of neurological morbidity in children; most survivors have permanent neurological deficits that affect the remainder of their life. Stroke in childhood, the focus of this Primer, is distinguished from perinatal stroke, defined as stroke before 29 days of age, because of its unique pathogenesis reflecting the maternal-fetal unit. Although approximately 15% of strokes in adults are haemorrhagic, half of incident strokes in children are haemorrhagic and half are ischaemic. The causes of childhood stroke are distinct from those in adults. Urgent brain imaging is essential to confirm the stroke diagnosis and guide decisions about hyperacute therapies. Secondary stroke prevention strongly depends on the underlying aetiology. While the past decade has seen substantial advances in paediatric stroke research, the quality of evidence for interventions, such as the rapid reperfusion therapies that have revolutionized arterial ischaemic stroke care in adults, remains low. Substantial time delays in diagnosis and treatment continue to challenge best possible care. Effective primary stroke prevention strategies in children with sickle cell disease represent a major success, yet barriers to implementation persist. The multidisciplinary members of the International Pediatric Stroke Organization are coordinating global efforts to tackle these challenges and improve the outcomes in children with cerebrovascular disease.
中风是儿童神经功能障碍的重要原因；大多数幸存者都有永久性的神经缺陷，影响他们的余生。本《指南》的重点是儿童中风，它与围产期中风不同，围产期中风定义为 29 天以内的中风，因为其独特的发病机制反映了母婴单位。尽管成年人中风的约 15%是出血性的，但儿童中风的一半是出血性的，一半是缺血性的。儿童中风的病因与成年人不同。紧急脑部成像对于确认中风诊断和指导超急性治疗决策至关重要。二级中风预防强烈取决于潜在病因。尽管过去十年在儿科中风研究方面取得了重大进展，但干预措施的证据质量仍然很低，例如快速再灌注治疗已经彻底改变了成年人的动脉缺血性中风治疗。诊断和治疗的大量时间延迟仍然是对最佳护理的挑战。镰状细胞病患儿的有效一级中风预防策略是一个重大成功，但实施仍存在障碍。国际儿科中风组织的多学科成员正在协调全球努力，以应对这些挑战并改善脑血管疾病患儿的结局。
