II. Epidemiology

  1. Incidence: 3-15 in 100,000 children per year
    1. Similar Incidence to Pediatric Brain Tumor

III. Types

  1. Acute ischemic Cerebrovascular Accident (55%)
  2. Hemorrhagic Cerebrovascular Accident
  3. Cerebral Venous Thrombosis

IV. Risk Factors

  1. Congenital Heart Disease
  2. Sickle Cell Anemia
  3. Head Trauma
  4. Vasculopathy or Vasculitis
  5. Coagulopathy
  6. Metabolic Disorders

V. Differential Diagnosis

  1. See Cerebrovacular Accident
  2. Common alternative diagnoses
    1. Complicated Migraine
    2. Hypoglycemia
    3. Seizure (post-ictal paralysis or Todd's Paralysis)

VI. Imaging

  1. CT Head
    1. Evaluate for Hemorrhagic Cerebrovascular Accident
  2. MRI/MRA Brain
    1. Discuss indications with neurology stroke team
    2. Do not delay definitive management (i.e. CVA Thrombolysis) if clear CVA findings and no Hemorrhage on CT Head
    3. If used to confirm Ischemic CVA within 3 hour time frame, then obtain stat with TPA ready to infuse

VII. Precautions

  1. Although rare in children, Cerebrovascular Accident is devastating
  2. Keep Cerebrovascular Accident on differential diagnosis in children
    1. Do not always assume benign cause (e.g. complicated Migraine Headache or post-Seizure Todd's paralysis)
  3. As with adults presenting with possible CVA, do not delay evaluation and management

VIII. Management

  1. See CVA Management
  2. See CVA Thrombolysis
  3. Consult neurology stroke team
  4. Consider TPA within 3 hours of Ischemic CVA
    1. Same dose as adults (0.9 mg/kg split dosing with 10% given as bolus and 90% given over 1 hour)
    2. Limited data regarding TPA in CVA under age 18 years old
    3. Amlie-Lefond (2009) Lancet Neurol 8(6): 530-6 [PubMed]
    4. Janjua (2007) Stroke 38(6): 1850-4 [PubMed]
  5. Antiplatelet Therapy following ischemic Cerebrovascular Accident
    1. Aspirin daily

IX. References

  1. Spangler and Sanossian in Herbert (2014) EM:Rap 14(3): 2-4

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