Understanding Pediatric Stroke: Etiology, Diagnosis, and Management in Children Under 15 Years

TL;DR

This review summarizes the causes, diagnosis, and treatment of stroke in children under 15, highlighting the challenges and need for better strategies.

Contribution

The paper provides a comprehensive review of pediatric stroke etiologies, diagnostic methods, and management challenges with a focus on recent evidence.

Findings

Cardioembolic sources, vascular abnormalities, hypercoagulable states, and infections are major causes of ischemic stroke in children.

MRI and MR angiography improve diagnostic accuracy, but are limited in resource-poor settings.

Thrombolysis in pediatric stroke lacks strong evidence, and adult treatment guidelines are not always applicable.

Abstract

Although rare in children under the age of 15, stroke is associated with significant mortality and long-term neurological morbidity. Understanding its underlying etiologies, accurate diagnostic modalities, and appropriate management is crucial for improving patient outcomes.

This narrative review article aims to summarize the current literature discussing the etiology, diagnosis, and management of stroke in children aged 15 years old or younger.

A comprehensive literature review was done using scientific databases such as PubMed, Scopus, and Google Scholar. The literature search included publications from 1997 to 2023, including peer-reviewed articles that specifically targeted pediatric stroke in patients under the age of 15 years. Only articles that specifically mentioned pediatric stroke were considered, excluding articles that specifically targeted adult patients, with a focus on more recent evidence in the management and therapeutic sections.

The review identifies cardioembolic sources, vascular abnormalities, hypercoagulable states, and infections as major etiologies of ischemic stroke in children. Hemorrhagic strokes, though less common, are primarily caused by trauma, aneurysms, and coagulopathies. While imaging modalities such as MRI and MR angiography have enhanced diagnostic accuracy, their availability is limited in resource-poor settings. Management is complicated by limited pediatric evidence supporting thrombolysis in pediatric ischemic stroke and the limited applicability of adult treatment guidelines.

Pediatric stroke is a rare but formidable diagnostic and therapeutic challenge due to its varied etiologies and clinical presentations. Early recognition and intervention are key to improving outcomes. Future research should focus on refining diagnostic strategies and developing targeted therapies for pediatric patients.

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