Pediatric emergency medicine trisk 2629 2629
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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
