Pediatric Stroke: The Global Challenges

Administrator: Sahar Hassanein

Overlooked strokes in children: how to overcome?
Sahar Hassanein
Recognition of acute stroke is often delayed for days or even missed in most children, especially in infants. Delay in the diagnosis of acute stroke in children is universal. This is a cause of missing the therapeutic window for hyperacute therapy and saving the brain tissue. Neuroimaging has an important role in early diagnosis and treatment of acute pediatric stroke. 
Pediatric stroke awareness for the lay people, emergency room doctors, and the general pediatricians is crucial for early diagnosis. Emphasis on clinical presentation and risk factors can increase stroke detection in the hyperacute stage. The importance of establishing a stroke pathway and networking for rapid stroke confirmation will be mentioned. Primary stroke prevention in high-risk groups will be highlighted especially in children with cardiac diseases, rheumatic and vascular diseases, following acute illness, gastroenteritis and dehydration, and sickle cell diseases. Secondary stroke prevention will be discussed. Stroke awareness among community, general pediatricians, and emergency room doctors, establishing stroke pathway, stroke networking, and prevention in high-risk group will be covered.

Diagnosis and management of Moyamoya angiopathy
Alvin Ndondo
(Moyamoya angiopathy (MMA) is a peculiar cerebrovascular condition characterized by progressive steno-occlusion of the terminal part of the internal carotid arteries (ICAs) and their proximal branches, associated with the development of a network of fragile collateral vessels at the base of the brain. The diagnosis is essentially made by radiological angiographic techniques. MMA is often idiopathic (moyamoya disease-MMD); conversely, it can be associated with acquired or hereditary conditions (moyamoya Syndrome-MMS); however, the pathophysiology underlying either MMD or MMS is poorly understood this reflects uncertainties and heterogeneity in patient management. MMD and MMS also have similar clinical expressions, including, above all, ischemic and hemorrhagic strokes, then headaches, seizures, cognitive impairment, and movement disorders. The available treatment strategies are currently shared between idiopathic MMD and MMS, including pharmacological and surgical stroke prevention treatments and symptomatic drugs. No pharmacological treatment is able to reverse the progressive disappearance of the ICAs. Antithrombotic agents are usually prescribed in ischemic MMA, although the coexisting hemorrhagic risk should be considered. Surgical revascularization techniques, which are currently the best available treatment in symptomatic MMA, are associated with good long-term outcomes and reduced ischemic and hemorrhagic risks.)