Childhood Arterial Ischaemic Stroke: Clinical Presentation, Risk Factors and Management

Lucia Gerstl; Michaela V. Bonfert; Florian Heinen; Martin Olivieri; Andreas Sebastian Schroeder; Moritz Tacke; Karin Kurnik; Christoph Bidlingmaier; Karl Reiter; Ingo Borggraefe

doi:10.1055/a-1113-0445

Hämostaseologie, Inhaltsverzeichnis

Hamostaseologie 2020; 40(02): 165-173
DOI: 10.1055/a-1113-0445

Review Article

Georg Thieme Verlag KG Stuttgart · New York

Childhood Arterial Ischaemic Stroke: Clinical Presentation, Risk Factors and Management

Authors

Lucia Gerstl

¹Division of Paediatric Neurology and Developmental Medicine, Department of Paediatrics, LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Munich, Germany
Michaela V. Bonfert

¹Division of Paediatric Neurology and Developmental Medicine, Department of Paediatrics, LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Munich, Germany
Florian Heinen

¹Division of Paediatric Neurology and Developmental Medicine, Department of Paediatrics, LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Munich, Germany
Martin Olivieri

²Division of Paediatric Hemostasis and Thrombosis, Department of Paediatric, LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Munich, Germany
Andreas Sebastian Schroeder

¹Division of Paediatric Neurology and Developmental Medicine, Department of Paediatrics, LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Munich, Germany
Moritz Tacke

¹Division of Paediatric Neurology and Developmental Medicine, Department of Paediatrics, LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Munich, Germany
Karin Kurnik

²Division of Paediatric Hemostasis and Thrombosis, Department of Paediatric, LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Munich, Germany
Christoph Bidlingmaier

²Division of Paediatric Hemostasis and Thrombosis, Department of Paediatric, LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Munich, Germany
Karl Reiter

³Division of Paediatric Intensive Care Medicine, Department of Paediatrics, LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Munich, Germany
Ingo Borggraefe

¹Division of Paediatric Neurology and Developmental Medicine, Department of Paediatrics, LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Munich, Germany

Abstract

Childhood arterial ischaemic stroke (AIS) is a rare, but potentially life-threatening event which requires early diagnosis and adequate treatment. The reported significant time delay to childhood AIS diagnosis may be associated with low awareness, the more nonspecific clinical presentation as well as difficult clinical differentiation to more common “stroke mimics” and a less established “acute care structure” with delayed access to proper neuroimaging. Compared with adult stroke care, experiences with acute reperfusion therapies like thrombolysis and mechanical thrombectomy are promising but limited and not based on clinical trials. The etiological work-up is absolutely essential, as the child's individual risk profile determines acute management, secondary prevention, risk of recurrence and outcome. Follow-up care should be organized in a multidisciplinary setting covering all bio-psycho-social aspects to achieve the best integration of the child into its educational, later professional and social environments.

Zusammenfassung

Der Schlaganfall im Kindes- und Jugendalter ist ein seltenes, aber potentiell lebensbedrohliches Ereignis und erfordert rasche Diagnosestellung und Therapie. Aufgrund der geringen Awareness, der häufigen unspezifischen klinsichen Präsentation mit einer Fülle zu bedenkender, wahrscheinlicherer Differenzialdiagnosen sowie der noch wenig etablierten Versorgungsstrukturen wird der kindliche Schlaganfall oft erst mit einer deutlichen Zeitverzögerung diagnostiziert. In der Erwachsenenneurologie etablierte Revaskularisationstherapien können in der Pädiatrie aktuell nur als off-label Therapien mit begrenzten Erfahrungen eingesetzt werden. Die ätiologische Abklärung ist unabdingbar, bestimmt doch das individuelle Risikoprofil neben Akutmanagement und Rezidivprophylaxe auch das Rezidivrisiko und Outcome. Die Langzeitbetreuung der betroffenen Kinder und Jugendlichen sollte im multidisziplinären Setting unter Berücksichtigung aller bio-psycho-sozialer Aspekte erfolgen. Denn neben dem klinisch neurologischen Outcome sind insbesondere auch die Auswirkungen des Schlaganfalls auf Kognition und Verhalten für eine erfolgreiche Integration des Kindes in sein schulisches und soziales Umfeld mitentscheidend.

Keywords

paediatric stroke - management - risk factors - symptoms

Schlüsselwörter

Schlaganfall - Pädiatrie - Symptome - Risikofaktoren - Therapie

Volltext

Referenzen

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