Stroke is defined by the World Health Organization as “a clinical syndrome typified by rapidly developing signs of focal or global disturbance of cerebral functions,
lasting more than 24 hrs or leading to death,
with no apparent causes other than vascular origin”1; is a major cause of morbidity and mortality in children worldwide and increasingly recognized cause of childhood disability.
Children is defined as the age group between 29 days after birth to 18 years.2,3
In developed countries the reported annual incidence of childhood stroke can ranges from 1.2 to 8 per 100,000 for children 4 or another one is little higher from 2.3 to 13 per 100,000 children per year 2.
Nethertheless,
Developing countries or underdeveloped countries are not known their rates.
Black children in the USA were at higher risk of death from all stroke types than white children,
and boys were at higher risk of hemorrhagic stroke death than girls.3
In children,
the diagnosis of stroke is not straightforward,
it is known that in adults,
the presentation will be more obvious; if children have difficulty understanding speech they may thought to be disobedient or deaf; or when they have difficulty expressing themselves in speech they may become aggressive of frustrated and may have tantrums or behave destructively.
1,2 Despite the parents note a change of behavior,
or present suddenly a neurological deficits,
stroke is often not the first diagnosis considerer by the medical providers.
Sometimes seizure (or change patron),
altered mental status,
headache,
migraine or lethargy can be associated with acute stroke in children.
2,4
One way to avoid delays or misdiagnoses would be to identify risk factors for stroke that would prompt more aggressive and timely investigation.
Multiple risk factors are often present in as many as 25% of children with stroke,
which means further investigations are warranted even when one risk factor has been identified.
Causes can be: cardiac,
hematologic,
infection,
vascular,
syndromic and metabolic disorders,
vasculitis,
oncologic and trauma ; being cardiac disease the most common cause of stroke in childhood,
accounting for up to a third of all Arterial ischemic stroke (AIS).
2,5
In our hospital we had seen because of vascular,
vasculitis and hematologic.
Stroke is divided in two types: ischemic and hemorrhagic; are almost evenly divided between both.
Ischemic stroke is further subclassified into arterial ischemic stroke (AIS) and cerebral sinovenous thrombosis (CSVT).
Hemorrhagic stroke include: spontaneous intracerebral hemorrhage with or without intraventricular extension,
intraventricular hemorrhage (IVH),
and non-traumatic subarachnoid hemorrhage.2,3 Almost all the cases that we had seen are ischemic stroke.
Neuroimaging is essential for diagnosis and differentiation of stroke from stroke mimics that can present similarly such as hypoglycemia,
demyelinating disorders,
tumors,
posterior reversible leukoencephalopathy syndrome,
and complex migraine.
Importantly neuroimaging is essential for identification of children who may be candidates for hyperacute therapy.2