THÔNG TIN TÀI LIỆU
more transient deficits Stroke is relatively rare in healthy children but may complicate a number of other pediatric medical conditions For example, among children with sickle cell disease, the incidence of stroke has been reported to be 6% to 9% Others at risk are those with various forms of cardiac disease, which is one of the most common causes of stroke in children Table 97.5 lists some of the common causes of stroke, as well as some more uncommon conditions in which stroke is a prominent clinical feature Generally, stroke is classified as either primarily ischemic (including embolic phenomena) or hemorrhagic In ischemic stroke, there is focal reduction in cerebral blood flow, with hypoxic damage to brain parenchyma, leading to neuronal injury and death Further damage ensues from reperfusion injury of ischemic areas Unlike in adults, there is currently no consensus on primary treatment for acute stroke in childhood This is due in large part to the rarity of stroke in children and therefore the lack of pediatric randomized controlled trials The efficacy of systemic thrombolytic therapy is yet to be determined and safety remains a primary concern The only multicenter prospective pediatric trial to date, the Thrombolysis in Pediatric Stroke Trial (TIPS), was terminated early due to slow enrollment Despite early termination, there were several significant findings from the TIPS trial Nearly 50% of eligible patients were ultimately found to have a stroke mimic This trial identified barriers to system and clinical readiness that lead to delayed recognition and diagnosis and brought to light the need for and value of multidisciplinary pediatric stroke teams While there are no national guidelines consensus, centers that successfully enrolled in the TIPS trial continue to successfully treat pediatric patients with tPA and up to 2% of pediatric stroke patients receive tPA Observational studies in children also suggest the feasibility and safety of primary endovascular therapies, including mechanical thrombectomy In the absence of consensus guidelines, these therapies should only be considered on a case-by-case basis at sites with dedicated multidisciplinary pediatric stroke teams, and the timing of administration must follow adult stroke guidelines In the face of limited data for primary treatment, attention to secondary prevention and factors that play an important part in determining the extent of damage after acute ischemia is critical Prevention of secondary injury is essential as up to 20% of children have clinical and/or radiologic recurrence
Ngày đăng: 22/10/2022, 13:27
Xem thêm: