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Pediatric stroke

Adriana Yock-Corrales, Flory Varela-Bulgarelli, Cary Barboza, Alfonso Gutierrez-Mata, Mark T Mackay, Franz Babl
OBJECTIVES: The aim was to describe clinical presentation, management, and outcomes of stroke in a tertiary emergency department (ED) of a developing country. METHODOLOGY: Retrospective case series of patients aged 1 month to 18 years presenting to an ED with radiological confirmed acute stroke during a 7-year period were studied. RESULTS: Ninety-five patients were identified. Twenty-five patients were excluded because of incomplete records (8) or not presenting via ED (17)...
October 4, 2016: Pediatric Emergency Care
Jennifer Shin Zank, Rani Singh, Michele Carney
Vigorous coughing leading to internal carotid artery dissection has been described in the adult literature but has not been reported in the pediatric population. We describe an 8-year-old right-handed girl who had a 1-week history of increased work of breathing and vigorous coughing. She initially presented to her pediatrician's office for her respiratory symptoms which improved with steroid therapy and albuterol treatments. However, she developed evolving left-sided motor weakness over the course of 2 days and presented to our pediatric emergency department where she was found to have an ischemic stroke in the right corona radiata with a right internal carotid artery dissection...
October 2016: Pediatric Emergency Care
Amy M DeLaroche, Lalitha Sivaswamy, Ahmad Farooqi, Nirupama Kannikeswaran
BACKGROUND: Identified barriers to the diagnosis of pediatric stroke include delays in provider recognition and definitive neuroimaging (magnetic resonance imaging). Clinical pathways are recommended to address these barriers; yet few studies have evaluated their impact. Our aim is to describe the effect of a pediatric stroke clinical pathway on the diagnosis of stroke in patients presenting with focal neurological dysfunction to a pediatric emergency department. METHODS: The pediatric stroke clinical pathway was implemented in our level 1 pediatric emergency department in June 2014 for children aged one month to 18 years...
September 13, 2016: Pediatric Neurology
I O Shchederkina, N N Zavadenko, I E Koltunov
AIM: To optimize a system of medical care, introduction of treatment and diagnostic guidelines, including secondary stroke prevention and rehabilitation measures, by implementation of pediatric stroke registry. MATERIAL AND METHODS: Fifty-seven patients, aged from 1 year to 17 years 11 months, included into the Moscow city registry of pediatric stroke were examined. Forty-two patients suffered ischemic stroke and 15 hemorrhagic stroke. RESULTS AND CONCLUSION: The diagnostic search for the causes of pediatric stroke is difficult due to the wide variety of etiologic factors and high frequency of their combinations...
2016: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
Ursula I Tuor, Min Qiao, Manasi Sule, Melissa Morgunov, Tadeusz Foniok
Stroke is a major cause of disability in adults and children. Recently, we have developed an adult rat model of minor stroke containing a peri-infarct region with a modest T2 increase and mild ischemic damage. We hypothesized that a neonatal minor stroke with mild peri-ischemic changes could also be produced, but with potential ontogenic differences. Using our minor photothrombosis method, we produced a range of severities of ischemic lesions (mini, minor, moderate and severe) within magnetic resonance imaging (MRI) slices of adult and neonatal rats...
October 12, 2016: NMR in Biomedicine
Géraldine Layani, Richard Fleet, Renée Dallaire, Fatoumata K Tounkara, Julien Poitras, Patrick Archambault, Jean-Marc Chauny, Mathieu Ouimet, Josée Gauthier, Gilles Dupuis, Alain Tanguay, Jean-Frédéric Lévesque, Geneviève Simard-Racine, Jeannie Haggerty, France Légaré
BACKGROUND: Evidence-based indicators of quality of care have been developed to improve care and performance in Canadian emergency departments. The feasibility of measuring these indicators has been assessed mainly in urban and academic emergency departments. We sought to assess the feasibility of measuring quality-of-care indicators in rural emergency departments in Quebec. METHODS: We previously identified rural emergency departments in Quebec that offered medical coverage with hospital beds 24 hours a day, 7 days a week and were located in rural areas or small towns as defined by Statistics Canada...
July 2016: CMAJ Open
Emily Riehm Meier, Angeli Rampersad
Once a fatal disease of childhood, more than 95% of patients born today with sickle cell disease (SCD) in developed countries are expected to survive into adulthood, largely because of improvements in supportive and preventive care (newborn screening, penicillin prophylaxis, transcranial Doppler (TCD) screening). Hydroxyurea (HU) therapy, the only oral medication currently available to prevent SCD complications, has become more widespread over the past 20 years. The NHLBI recommends that HU be offered to all patients with HbSS beginning at nine months of age, and the recently published Abnormal TCD with Transfusions Changing to HU (TWiTCH) trial has shown HU as an acceptable alternative to transfusion therapy for patients at high risk of stroke...
October 5, 2016: Pediatric Research
Jeffrey Steinberg, Vincent Cheung, Gunjan Goel, J Scott Pannell, Javan Nation, Alexander Khalessi
Although there have been reports of carotid artery pseudoaneurysm formation after adenoidectomy and/or tonsillectomy secondary to iatrogenic injury, there are no case reports of successful endovascular reconstruction of the injured artery in the pediatric population. In most pediatric cases, the internal carotid artery (ICA) is sacrificed. The authors report on a 6-year-old girl who presented with odynophagia, left-sided Horner's syndrome, hematemesis, and severe anemia 6 months after a tonsillectomy. On examination she was found to have a pulsatile mass along the left posterior lateral oropharynx, and imaging demonstrated a dissection of the extracranial left ICA and an associated pseudoaneurysm...
September 30, 2016: Journal of Neurosurgery. Pediatrics
J Fluss, M Dinomais, M Kossotoroff, C Vuillerot, S Darteyre, S Chabrier
Over the last decade considerable advances have been made in the identification, understanding and management of pediatric arterial ischemic stroke. Such increasing knowledge has also brought new perspectives and interrogations in the current acute and rehabilitative care of these patients. Areas covered: In developed countries, focal cerebral arteriopathy is one of the most common causes of arterial ischemic stroke in childhood and imaging features are well characterized. However, there are ongoing debates regarding its underlying mechanisms, natural evolution and proper management...
October 12, 2016: Expert Review of Neurotherapeutics
Marie-Doriane Morard, Carole Vuillerot, Mickael Dinomais, Stéphane Chabrier, Mathilde Chevignard, Kim Bull, Eleni Papathanasiou
OBJECTIVE: To translate and validate a French version of the Pediatric Stroke Outcome Measure - summary of impressions (PSOM-SOI), for application in a population of French children after neonatal arterial ischemic stroke (NAIS). The PSOM measures deficiency of body functions and structures. On completion of this examination, the PSOM-SOI was developed containing and scoring 5 subscales: right sensorimotor, left sensorimotor (each with subcategories), language production, language comprehension and cognitive/behavioral...
September 2016: Annals of Physical and Rehabilitation Medicine
Eleni Papathanasiou, Mathilde Chevignard, Carole Vuillerot, Anne Tiberghien, Ingrid Godard
OBJECTIVE: Paediatric stroke is a relatively rare medical condition, but it often leads to long lasting motor and cognitive impairments. Rehabilitation of motor impairments has been widely studied, with most studies performed in children with cerebral palsy (CP). However, CP covers a variety of medical conditions, including brain lesions due to paediatric stroke occurring early in life, but not stroke occurring later on during childhood. The specificity of rehabilitation after paediatric stroke remains understudied...
September 2016: Annals of Physical and Rehabilitation Medicine
Carole Vuillerot, Mickael Dinomais, Stephane Marret, Stephane Chabrier, Thierry Debillon
Neonatal arterial ischemic stroke (NAIS) affects one child in 6-17 100,000-birth term neonates, most of these children will keep long-term motor and cognitive impairment. In 2014, initiated by the French Center for Pediatric Stroke in association with the French Society of Neonatology, a steering committee was created to propose clinical guidelines after NAIS. From all the relevant questions, the importance is given to long-term outcomes after a NAIS with a need for a better description of motor and cognitive outcomes after a NAIS in order to propose a more consensual monitoring for these children to improve their management...
September 2016: Annals of Physical and Rehabilitation Medicine
Kh Rezaee, E Azizi, J Haddadnia
BACKGROUND: Epilepsy is a severe disorder of the central nervous system that predisposes the person to recurrent seizures. Fifty million people worldwide suffer from epilepsy; after Alzheimer's and stroke, it is the third widespread nervous disorder. OBJECTIVE: In this paper, an algorithm to detect the onset of epileptic seizures based on the analysis of brain electrical signals (EEG) has been proposed. 844 hours of EEG were recorded form 23 pediatric patients consecutively with 163 occurrences of seizures...
June 2016: Journal of Biomedical Physics & Engineering
Ha Neul Lee, Soyong Eom, Se Hoon Kim, Hoon-Chul Kang, Joon Soo Lee, Heung Dong Kim, Young-Mock Lee
BACKGROUND: Epileptic seizures in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) are heterogeneous with no pathognomonic features. We reviewed epilepsy characteristics and clinical outcome exclusively in a pediatric population. METHODS: Twenty-two children and adolescents (13 males) with confirmed mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes due to mitochondrial DNA A3243G mutation and epilepsy were recruited...
August 26, 2016: Pediatric Neurology
Krishnan N Subrahmanian, Young H Shim, Mona D Shah, Brandon H Tran, Alexandra M Stevens, Andrea T Cruz
Emergency departments (EDs) are alert to the possibility of stroke and the need for early interventions to improve long-term clinical outcomes. However, new-onset hemiparesis in pediatric patients with leukemia may be due to a number of different etiologies, including most common side effects from chemotherapeutic agents. We present a case of a 15-year-old boy with pre-B acute lymphoblastic leukemia on chemotherapy, having recently received a high-dose methotrexate infusion in addition to intrathecal methotrexate therapy, who presented to our ED with acute right-sided hemiparesis...
September 23, 2016: Pediatric Emergency Care
Andrea Andrade, Sandra Bigi, Suzanne Laughlin, Sujatha Parthasarathy, Adriane Sinclair, Peter Dirks, Ann Marie Pontigon, Mahendranath Moharir, Rand Askalan, Daune MacGregor, Gabrielle deVeber
BACKGROUND: Malignant middle cerebral artery infarct syndrome is a potentially fatal complication of stroke that is poorly understood in children. We studied the frequency, associated characteristics, and outcomes of this condition in children. METHODS: Children, aged two months to 18 years with acute middle cerebral artery infarct diagnosed at our center between January 2005 and December 2012 were studied. Associations with malignant middle cerebral artery infarct syndrome were sought, including age, seizures, neurological deficit severity (Pediatric National Institute of Health Stroke Severity Score), stroke etiology, fever, blood pressure, blood glucose, infarct location, infarct volume (modified pediatric Alberta Stroke Program Early Computed Tomography Score), and arterial occlusion...
August 27, 2016: Pediatric Neurology
Stephen Robert Daniels
Hypertension in children and adolescents is associated with both short and long-term abnormalities in the cardiovascular system. Ultimately, these changes can lead to myocardial infarction, stroke, congestive heart failure and chronic renal disease, all of which are associated with substantial morbidity and mortality.In the short term, the best evidence that hypertension is adversely impacting the heart and vasculature is the development of left ventricular hypertrophy, increased vascular stiffness and endothelial dysfunction...
September 2016: Journal of Hypertension
M Trolliet, A Sevely, J-F Albucher, N Nasr, C Hachon Lecamus, K Deiva, E Cheuret
Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by thunderclap headaches with diffuse segmental constriction of cerebral arteries that resolves spontaneously within 3 months. We report on a case of a 13-year-old boy presenting with acute severe headaches, triggered by physical exertion. His past medical history was uneventful. Moderate headache persisted between exacerbations for 4 weeks. He secondarily presented with signs of intracranial hypertension. Brain magnetic resonance angiography (MRA) revealed multifocal narrowing of the cerebral arteries...
September 14, 2016: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Manon At Bloemen, Tim Takken, Frank Jg Backx, Marleen Vos, Cas Ljj Kruitwagen, Janke F de Groot
OBJECTIVE: To determine content validity of the Muscle Power Sprint Test (MPST) and construct validity and reliability of the MPST, 10x5 Meter Sprint Test (10x5MST), slalom test and one stroke push test (1SPT) in wheelchair-using youth with spina bifida (SB). DESIGN: Clinimetric study SETTING: Rehabilitation centers, SB outpatient services, private practices PARTICIPANTS: A convenience sample of 53 children (5-19 years, 32 boys / 21 girls) with SB who use a manual wheelchair...
September 12, 2016: Archives of Physical Medicine and Rehabilitation
Timothy J Bernard, Lauren A Beslow, Marilyn J Manco-Johnson, Jennifer Armstrong-Wells, Richard Boada, David Weitzenkamp, Amanda Hollatz, Sharon Poisson, Catherine Amlie-Lefond, Warren Lo, Gabrielle deVeber, Neil A Goldenberg, Michael M Dowling, E Steve Roach, Heather J Fullerton, Susanne M Benseler, Lori C Jordan, Adam Kirton, Rebecca N Ichord
BACKGROUND AND PURPOSE: There are limited data about the reliability of subtype classification in childhood arterial ischemic stroke, an issue that prompted the IPSS (International Pediatric Stroke Study) to develop the CASCADE criteria (Childhood AIS Standardized Classification and Diagnostic Evaluation). Our purpose was to determine the CASCADE criteria's reliability in a population of children with stroke. METHODS: Eight raters from the IPSS reviewed neuroimaging and clinical records of 64 cases (16 cases each) randomly selected from a prospectively collected cohort of 113 children with arterial ischemic stroke and classified them using the CASCADE criteria...
October 2016: Stroke; a Journal of Cerebral Circulation
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