Abstract: Strokes in childhood, although relatively uncommon, have high rates
of morbidity and mortality. The clinical findings of ischemic and hemorrhagic
strokes are reviewed; both have a significant recurrence risk while the latter
carries a particularly high mortality, although outcome in survivors may be
better. Neonatal strokes also have to be considered and have variable outcome,
although death and recurrence are uncommon. Risk factors for childhood strokes
differ from those causing strokes in adults. Cardiac and blood disorders, for
instance congenital heart disease and sickle cell disease, are obvious
examples, and now more attention is being given to coagulation and metabolic
disorders. Infections, especially those due to viruses such as varicella, can
precipitate strokes in children, and there are a number of genetically
determined conditions, that can lead to strokes. The latter include blood and
metabolic diseases, as well as mitochondrial disorders, which can mimic
childhood strokes. Other mimics may also be serious but others are not, such as
migraine and syncope. The management of children who have suffered a stroke has
to be considered in both the short and long term. For ischemic stroke,
management considerations include the use of aspirin, anticoagulants and
thrombolytic agents, while hemorrhagic stroke may require emergency
neurosurgery and a multidisciplinary team to reduce the risk of recurrence.
Rehabilitation requires the involvement of a variety of therapists and needs
further study, but assessment of affected children for special educational
needs will almost certainly be required.
