Pediatric Ischemic Stroke - Review Article - Risk Factors, Acute Management, and Sequelae

Oct 11, 2026

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Pediatric cerebrovascular disease is a leading cause of death and disability, and survivors and families often face long-lasting sequelae that hinder school reintegration and later independence. Because childhood stroke is rare, many front-line providers are less prepared than they are for adult emergent care. This review summarizes risk factors, acute management, and outcomes of pediatric ischemic stroke, highlighting that evidence for reperfusion therapies is still limited but evolving, with thrombolysis and thrombectomy considered in hyperacute settings.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages18

Reading Time45 min

AccessFree to download

Abstract

Objective

Latest Developments

Essential Points

Introduction

Hyperacute Treatment for Pediatric Stroke

REVIEW ARTICLE 􀀁 CONTINUUM AUDIO INTERVIEW AVAILABLE ON LINE CITE AS : CONTINUUM ( MIN NEA P M INN) 2023;29(2, CEREBROVASCULAR DISEASE):566–583. Address correspondence to Dr Christine Fox , Sandler Neurosciences Center, University of California San Francisco, 675 Nelson Rising Ln, 3rd Floor, San Francisco, CA 94143, [christine.fox@ucsf.edu](christine.fox@ucsf.edu). RELATIONSHIP DISCLOSURE: The institution of Dr Fox has received personal compensation in the range of $500 to $4999 for serving as a consultant for Competitive Drug Development International Ltd, research support from the American Heart Association/ Bugher Foundation , and the National Institutes of Health/ National Institute of Neurological Disorders and Stroke, and has received publishing royalties from a publication relating to health care. UNLABE LED USE OF PRODUCTS/INVESTIGATIONAL USE D ISCLOSUR E: Dr Fox discusses the use of thrombolysis and thrombectomy for the treatment of stroke in children. © 2023 American Academy of Neurology. Pediatric Ischemic Stroke By Christine Fox , MD, MAS ABSTRACT OBJECTIVE: Pediatric cerebrovascular disease is one of the leading causes of death and disability in children. Survivors of childhood stroke and their families are often left to cope with long-lasting sequelae, such as barriers to school reentry and long-term challenges in attaining independence as adults. Because childhood stroke is rare and providers may not be familiar with the disorder, this article reviews the risk factors, acute management, and sequelae of ischemic stroke in children. LATEST DEVELOPMENTS: High-quality evidence has resulted in an organized approach to emergent treatment of ischemic stroke in adults, but most front-line providers are less prepared for emergent stroke management in children. The level of evidence for reperfusion therapies in children remains low but is growing. Thrombolysis and thrombectomy are sometimes considered for hyperacute treatment of stroke in children. Readiness for pediatric stroke at regional centers should include an organized approach to pediatric stroke triage and management based on extrapolation from adult stroke trials, expert consensus, and emerging pediatric studies. ESSENTIAL POINTS:This review provides up-to-date information about ischemic stroke risk factors and management in children. Preparation for rapid stroke diagnosis and management in children may improve outcomes. INTRODUCTION S troke is uncommon in children but can be a major cause of childhood mortality and morbidity when it occurs. When occurring at a young age, stroke can result in long-term neurologic sequelae and disabilities over many years. Both acute and chronic care for a child with stroke are costly. The lifetime costs for care of a child who had a stroke are generally higher than the costs of similar types of strokes in adults, and the economic burden for society is sustained over a longer period of time.1 Adjusting to new disabilities from a stroke can be difficult for children and their families. Beyond physical health, the toll on mental and emotional health is often high forchildren and caregivers. For these reasons, effective stroke treatments to improve neurologic outcomes for children are essential. By convention, a stroke that occurs in children after the first 28 days of life is considered a childhood stroke. A stroke that occurs during the first 28 days of life is considered a perinatal stroke. Perinatal arterial ischemic stroke occurs in approximately one in 3000 live full-term births,2 which makes the weeks around birth one of the highest-risk time periods for stroke to occur. The term presumed perinatal stroke is used when imaging demonstrates a chronic infarct in an older 566 APRIL 2023 child who begins to show focal deficits during development. Childhood and perinatal strokes are categorized as distinct entities because management, workup, risk factors, and secondary stroke preventio

FAQs

What does the review aim to cover about pediatric ischemic stroke?

It reviews risk factors, acute management, and sequelae of ischemic stroke in children, emphasizing preparation for rapid diagnosis and treatment.

Why is pediatric stroke care challenging compared with adult stroke care?

Childhood stroke is uncommon, so many providers are less familiar with emergent pediatric stroke management, and time of onset and neurologic deficit assessment can be harder in young children.

What reperfusion therapies are discussed for children with hyperacute stroke?

Thrombolysis and mechanical thrombectomy are discussed as treatments sometimes considered for hyperacute care, although evidence in children remains limited but is growing.

Oct 11, 2026

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