Department of Neurology, Sydney Children's Hospital, Randwick, NSW, Australia.
Department of Neurointervention, Prince of Wales Hospital, Randwick, NSW, Australia.
Dev Med Child Neurol. 2023 Jan;65(1):126-135. doi: 10.1111/dmcn.15285. Epub 2022 Jun 5.
To improve delivery of acute therapies for acute ischaemic stroke (AIS).
We identified factors influencing the speed of diagnosis and delivery of acute therapies in a prospective cohort of 21 children with suspected AIS (eight with AIS, 13 stroke mimics) and explored them in a retrospective cohort with confirmed AIS.
Approximately half of the prospective and total AIS cohorts presented with acute, sustained hemiparesis, and were diagnosed relatively quickly. AIS was suspected and diagnosed more slowly in the half presenting with symptoms other than sustained hemiparesis. Thirty-one out of 51 patients with AIS (19 females, 32 males, mean age 8 years 6 months, SD 5 years 4 months) had arterial abnormalities identified by computed tomography angiography (CTA) or magnetic resonance angiography (MRA): 11 with large vessel occlusion, six with dissection, five with moyamoya disease, nine with other arteriopathies. Among these patients, those initially imaged with CTA were diagnosed more quickly than those with initial magnetic resonance imaging/angiography, which facilitated thrombectomy and thrombolytic therapy. Twenty out of 51 had AIS without arterial abnormalities on CTA or MRA: eight with lenticulostriate vasculopathy and 12 with other small-vessel AIS. Among these patients, 80% were ineligible for thrombolysis for reasons beyond delay to diagnosis, and all showed good outcomes with supportive treatments alone.
Clinical features at presentation influence rapidity with which childhood AIS is suspected and diagnosed. Readily available CTA can direct thrombectomy in patients with large vessel occlusion and thrombolysis in most, but not all, eligible patients.
Children with acute ischaemic stroke (AIS) commonly present with symptoms other than sustained hemiparesis. Stroke is more slowly recognized in these patients, which limits potential therapies. Computed tomography angiography (CTA) accurately identifies AIS with large vessel occlusion, enabling timely endovascular thrombectomy. CTA is sufficient to direct thrombolytic therapy in most eligible children. Most childhood AIS without arterial abnormalities identified by CTA had good outcomes.
提高急性缺血性脑卒中（AIS）的急性治疗效果。
我们在 21 名疑似 AIS 的患儿前瞻性队列中确定了影响诊断和急性治疗速度的因素（8 名 AIS，13 名脑卒中模拟患者），并在确诊为 AIS 的回顾性队列中进行了探索。
约一半的前瞻性和 AIS 总队列出现急性、持续性偏瘫，诊断相对较快。出现持续性偏瘫以外症状的 AIS 患儿的诊断速度较慢。51 例 AIS 患者中有 31 例（19 名女性，32 名男性，平均年龄 8 岁 6 个月，标准差 5 岁 4 个月）通过计算机断层血管造影术（CTA）或磁共振血管造影术（MRA）发现动脉异常：11 例大血管闭塞，6 例夹层，5 例烟雾病，9 例其他动脉病变。这些患者中，初始 CTA 成像的患者比初始磁共振成像/血管造影的患者诊断更快，这有助于进行血栓切除术和溶栓治疗。51 例患者中有 20 例 CTA 或 MRA 无动脉异常：8 例纹状体血管病，12 例其他小血管 AIS。这些患者中，80%由于诊断延迟以外的原因不能进行溶栓治疗，所有患者仅通过支持性治疗即获得良好预后。
发病时的临床特征影响儿童 AIS 的怀疑和诊断速度。可快速获得的 CTA 可以指导大血管闭塞患者进行血栓切除术，以及大多数（但不是全部）符合条件的患者进行溶栓治疗。
患有急性缺血性脑卒中（AIS）的儿童通常表现为持续性偏瘫以外的症状。这些患者的中风识别速度较慢，限制了潜在的治疗方法。计算机断层血管造影术（CTA）准确识别大血管闭塞性 AIS，从而实现及时的血管内血栓切除术。CTA 足以指导大多数符合条件的儿童进行溶栓治疗。大多数通过 CTA 未发现动脉异常的儿童 AIS 预后良好。
