Pediatric emergency medicine trisk 2625 2625
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Clinical Indications for Discharge/Admission. Patients with mild symptoms
and good response to LP may be discharged home with close follow-up arranged.
Children with severe or persistent symptoms or those with visual changes may
require hospital admission. Intracranial hypertension may be recurrent or chronic,
and long-term monitoring, particularly of visual function, is important.
STROKE/CEREBROVASCULAR ACCIDENT
Goals of Treatment
The treatment of pediatric stroke remains understudied. In the absence of
consensus guidelines for the primary treatment of acute stroke, the goals of
treatment should focus on early recognition and prevention of secondary injury.
This can be better achieved by multidisciplinary pediatric acute stroke teams with
well-established protocols. Acute onset of a focal neurologic deficit or seizure
activity in the young child should raise the clinician’s level of suspicion. Early
diagnosis should be made through the use of cross-sectional neuroimaging.
Strategies to reduce disease progression and stroke recurrence should include
maintenance of euthermia, euglycemia, and normotension, as well as the
treatment of hypoxemia and seizure activity, if present.
CLINICAL PEARLS AND PITFALLS
Presentation of stroke in children is highly variable.
Hemorrhagic strokes are relatively more common in children than
adults.
MRI with diffusion-weighted imaging is considered the most sensitive
modality for detecting early changes associated with stroke, however,
the choice of initial imaging modality should take into account the
speed of access and the need for anesthesia.
There are no consensus guidelines for the routine use of endovascular
therapy, including tPA.
Pediatric centers that treat stroke should develop multidisciplinary
teams and guidelines to improve recognition, diagnosis, and treatment.
Current Evidence
Stroke is defined as a syndrome of acute onset of focal neurologic deficit that
persists for more than 24 hours, although some pediatric neurologists include
