Department of Paediatric Neurology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Semin Pediatr Neurol. 2022 Dec;44:100996. doi: 10.1016/j.spen.2022.100996. Epub 2022 Sep 19.
Childhood stroke is not as common as adult stroke, but it is underrecognized the world over. Diagnosis is often delayed due to lack of awareness not only by the lay public but also by emergency and front-line health care workers. Despite the relative rarity of childhood stroke, the impact on morbidity, mortality and the economic burden for families and society is high, especially in poorly resourced settings. The risk factors for stroke in children differ from the adult population where lifestyle factors play a more important role. The developmental aspects of the pediatric cerebral vasculature and hematological maturational biology affects the clinical presentation, investigation, management and outcomes of childhood stroke in a different way compared to adults. The management of childhood stroke is currently based on expert guidelines and evidence extrapolated from adult studies. Hyperacute therapies that have revolutionized the treatment of stroke in adults cannot be easily applied to children at this stage due to the diagnostic delays, diverse risk factors and developmental considerations mentioned above. Much has been achieved in the understanding of genetic, acquired, preventable and recurrent stroke risk factors in the past decade through international collaborative efforts like the International Pediatric Stroke Study. Evidence for the prevention and treatment of childhood stroke remains elusive. Even more elusive are relevant and achievable management guidelines for pediatric stroke in resource-limited settings. This narrative review focusses on the current management practices globally, emphasizing the challenges, and gaps in knowledge of pediatric stroke in low- and middle-income countries and other areas with limited resources. Priorities and some potential solutions at national and local level are suggested for these settings.
儿童中风不如成人中风常见，但在世界范围内，人们对其认识不足。由于不仅普通大众，而且急诊和一线医护人员缺乏认识，因此诊断常常延误。尽管儿童中风相对少见，但对发病率、死亡率以及对家庭和社会的经济负担的影响仍然很高，尤其是在资源匮乏的环境中。儿童中风的危险因素与成年人不同，后者的生活方式因素更为重要。儿科脑血管和血液成熟生物学的发育方面以不同于成年人的方式影响儿童中风的临床表现、检查、管理和结果。儿童中风的管理目前基于专家指南和从成人研究中推断出的证据。由于上述诊断延迟、多样化的危险因素和发育方面的考虑，现阶段无法轻易将在成人中风治疗中取得革命性进展的超急性治疗方法应用于儿童。在过去十年中，通过国际儿科中风研究等国际合作努力，人们在了解遗传、获得性、可预防和复发性中风危险因素方面取得了很大进展。预防和治疗儿童中风的证据仍然难以捉摸。在资源有限的环境中，特别是在中低收入国家和其他资源有限的地区，有关儿童中风的管理指南更是难以捉摸。本文重点介绍了全球当前的管理实践，强调了在中低收入国家和其他资源有限地区，对儿童中风的认识存在挑战和差距。针对这些情况，提出了在国家和地方层面的优先事项和一些潜在的解决方案。
