Stroke in Children
Important differences from adults characterize childhood stroke: 1) predisposing factors (e.g., cyanotic heart disease) common; 2) clinical evolution (outcome often better in children); 3) anatomic site of pathology (e.g., internal carotid artery occlusions often intracranial rather than extracranial; cerebral aneurysms typically peripheral rather than near circle of Willis).
Incidence
Low overall: annual incidence 2.5/100,000 children in one study.
Groups with increased risk: patients with sickle cell disease (7% to 11% have stroke before age 20 years); premature infants (those <1,500 g in intensive care for >24 hours: 50% incidence of subependymal or intraventricular hemorrhage); children with congenital heart disease.
Arterial Thrombosis
Arterial compression: trauma, tumor, craniometaphyseal dysplasia, retropharyngeal abscess.
Sickle-cell disease: see Chapter 147.
Extracranial carotid occlusion: usually due to head or neck trauma.
Basal occlusive disease with telangiectasia (moyamoya): “puff of smoke” appearance on angiogram; stenosis of arteries at base of brain; often bilateral; prominent telangiectasia. Most are idiopathic. May complicate sickle-cell disease, bacterial or tuberculous meningitis, neurofibromatosis, radiotherapy. Often recurs.
Table 44.1 Etiology of Stroke in Children | |||||||||||||||||||||||||||||||||||||||||||
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