Hyperacute Therapies for Childhood Stroke: A Case Report and Review of the Literature

Objective. The optimal management of pediatric patients with arterial ischemic stroke (AIS) is not known. Despite this, goal-oriented, time-sensitive therapies geared to rapid reestablishment of arterial blood flow are occasionally applied with beneficial effects. The inconsistent approach to AIS is in part due to a lack of knowledge and preparedness.Methods. Case report of a 12-year-old male with right middle cerebral artery (MCA) occlusion resulting in dense left hemiplegia and mutism and review of the literature.Intervention(s). Mechanical thrombectomy, intra-arterial administration of rt-PA, vasodilators, and platelet inhibitors, and systemic anticoagulation and subsequent critical care support.Results. Restoration of right MCA blood flow and complete resolution of neurologic deficits.Conclusion. We report the gratifying outcome of treatment of a case of AIS in a pediatric patient treated with hyperacute therapies geared to arterial recanalization and subsequent neurologic critical care and review the pertinent literature. Guidelines for the emergency room management of pediatric AIS from prospective, randomized trials are needed.

Arterial Dissection and Vascular Trauma

Traumatic intra-extracranial arterial injuries still represent common events of both closed head injury and penetrating head trauma. These injuries include arterial dissection, pseudoaneurysms and fistulas, both direct and indirect. Although these lesions may be identified while still asymptomatic, they usually present in a delayed fashion with intracranial hemorrhage, focal cerebral ischemia or life-threatening epistaxis. Endovascular therapy has played a major role in the management of these lesions but only with senior full trained neurointerventionists and on the principles of a neurologic critical care team to minimize secondary brain injuries.