November Up2Date
Pediatric Stroke
They are not little adults
Most children with Acute Ischemic Stroke present with a GCS of 14 or greater and at least one
focal neurologic sign, whereas hemorrhagic stroke typically presents with headache, vomiting
and mental status change (1).
Two-thirds of pediatric patients presenting with stroke do not have screening indications
according to adult protocols (2).
Childhood Acute Ischemic Stroke is fatal in approximately 3% of patients and is associated with
both acute and long-term neurologic impairment in over 70% of cases (3).
Etiologies of pediatric stroke include: sickle cell disease, congenital heart disease, arterial
dissection, prothrombotic conditions, preceding viral infections and one in four cases is
idiopathic (3).
They are sneaky little ones
The median interval from symptom onset to Acute Ischemic Stroke diagnosis is 22.7 hours.
Prehospital delay, symptom onset to hospital arrival, is 1.7 hours (4).
Initial neuroimaging can only diagnosis a stroke in the pediatric patient approximately 47% of
the time (4).
The parents’ delay in requesting medical help, the non abrupt onset of symptoms, altered level
of consciousness, milder stroke severity, posterior circulation infarction and lack of
Pediatric Stroke
They are not little adults
Most children with Acute Ischemic Stroke present with a GCS of 14 or greater and at least one
focal neurologic sign, whereas hemorrhagic stroke typically presents with headache, vomiting
and mental status change (1).
Two-thirds of pediatric patients presenting with stroke do not have screening indications
according to adult protocols (2).
Childhood Acute Ischemic Stroke is fatal in approximately 3% of patients and is associated with
both acute and long-term neurologic impairment in over 70% of cases (3).
Etiologies of pediatric stroke include: sickle cell disease, congenital heart disease, arterial
dissection, prothrombotic conditions, preceding viral infections and one in four cases is
idiopathic (3).
They are sneaky little ones
The median interval from symptom onset to Acute Ischemic Stroke diagnosis is 22.7 hours.
Prehospital delay, symptom onset to hospital arrival, is 1.7 hours (4).
Initial neuroimaging can only diagnosis a stroke in the pediatric patient approximately 47% of
the time (4).
The parents’ delay in requesting medical help, the non abrupt onset of symptoms, altered level
of consciousness, milder stroke severity, posterior circulation infarction and lack of
