Pediatric Ischemic Stroke: Acute Management and Areas of Research

troke is defined as the rapid loss of brain function due to a decreased cerebral blood flow (CBF). It is a relatively rare disease in childhood, with an estimated incidence of 2.6-6.4/100 000/year and serious long-term morbidity. Ischemic stroke in children typically refers to arterial ischemic stroke (AIS). It is more frequent in the perinatal period (between 28 weeks of gestation to 28 days after birth) than in childhood (Figure 1; available at www.jpeds. com). The clinical presentation of AIS differs depending on age, involved artery, and cause. In newborns, seizures, apneas, hypotonia, episodes of duskiness, irritability, or poor feeding are common presenting symptoms. In children, frequently reported signs are focal neurologic deficits such as hemiplegia. The vascular territory of the middle cerebral artery (MCA) is the most frequently affected. We have primarily focused on pediatric stroke because neonatal stroke represents a different entity from a medical, epidemiologic, and pathophysiologic perspective.