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Coagulopathies (e.g., hemophilia) Anticoagulant deficiency (protein C, protein S, antithrombin III) Polycythemia Acute myelogenous leukemia Systemic lupus erythematosus Neurocutaneous syndromes Neurofibromatosis Tuberous sclerosis Sturge–Weber syndrome Clinical Considerations Clinical Recognition The presentation of stroke in children is highly variable, and is influenced by the child’s age and the portion of the cerebral vasculature affected Facial weakness, arm weakness, and inability to walk have been associated with increased likelihood of stroke In neonates and young children, however, seizure may be the only presenting symptom Involvement of the anterior cerebral artery leads primarily to lower-extremity weakness, whereas compromise of the middle cerebral artery circulation produces hemiplegia with upper limb predominance, hemianopsia, and possibly dysphasia Less commonly, the posterior circulation is affected, which results in vertigo, ataxia, and nystagmus, as well as hemiparesis and hemianopsia Older children often have concomitant headache The child with a stroke may also have a diminished level of consciousness Triage Considerations Any child with an acute neurologic deficit requires prompt evaluation Suspicion for stroke should be increased in children with predisposing medical conditions such as sickle cell disease and congenital cardiac disease Clinical Assessment Because stroke can have a highly variable and at times subtle presentation, a thorough neurologic examination is necessary in any patient presenting with a neurologic deficit, seizure, or alteration of consciousness Any new neurologic symptom or complaint in patients with underlying sickle cell disease merits close evaluation Particular attention should be paid to identifying risk factors as the majority of children have at least one identifiable risk factor at the time of infarction In addition, physicians need to consider other etiologies that may
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