Management of Pediatric Stroke - Challenges and Perspectives from Resource-limited Settings

Topic: Management of Pediatric Stroke - Challenges and Perspectives from Resource-limited Settings.

Talk By: Dr. Alvin Ndondo.

When: February 10, 2024, at 09:00 AM Eastern Time ( US/ Canada ).

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Dr. Alvin Ndondo is currently working as a consultant/sub-specialist in Paediatric Neurology at the Red Cross War Memorial Children’s Hospital in Cape Town, South Africa. He holds a joint staff appointment and is a lecturer at the University of Cape Town (UCT). He is part of several paediatric neurology multidisciplinary clinics, including the neurocutaneous disorders, neuromuscular diseases, neurometabolic and epilepsy clinics. He has an interest in paediatric neurometabolic conditions, movement disorders and childhood stroke.

Management of Paediatric Stroke – Challenges and Perspectives from Resource-limited Settings: The challenges in diagnosing stroke in childhood include lack of awareness, delayed recognition, non-specific clinical signs (in the very young), neuroimaging availability (and necessary sedation for young children), and stroke mimics. Added to these globally recognised general diagnostic challenges and the lack of evidence in the treatment of stroke in childhood, the lack of resources, and paucity of research data compounds the development of management guidelines in low- and middle-income countries (LMICs). The impact in these resource-limited settings, including countries in Sub-Saharan Africa, is exacerbated by the unique stroke risk factors that prevail there. Infectious diseases, including human immunodeficiency virus (HIV) and tuberculosis (TB), bacterial meningitis, rheumatic heart disease, and sickle cell disease (SCD), collide with struggling health systems with limited capacity, poverty, and lack of material and human resources. Infectious diseases including human immunodeficiency virus (HIV) and tuberculosis (TB), bacterial meningitis, rheumatic heart disease and sickle cell disease (SCD) collide with struggling health systems with limited capacity, poverty, and lack of material and human resources. These pose a great challenge to any attempts to roll out international recommendations for the management of paediatric stroke in major parts of Africa, Asia, and South America. This talk will focus predominantly on the management of childhood arterial ischaemic stroke (AIS) with these risk factors in mind. Possible solutions to overcome the challenges mentioned above will be suggested.

By attending the session, you will be able to learn the following points:

• Arterial ischaemic stroke is more common in adults than children, but the diagnosis in children is often missed or delayed.
• Some of the major risk factors for stroke in resource-limited settings like Sub-Saharan Africa include bacterial and tuberculous meningitis (TBM), Human Immunodeficiency Virus (HIV), and Sickle cell Disease (SCD).
• Understanding the ensuing inflammation in TB and HIV is important, with the potential for adding adjuvants (e.g. immunomodulation) to antimicrobial therapy in the treatment of arterial ischaemic stroke in these situations.
• Possible broader strategies in the implementation of international stroke guidelines will include task-shifting, adult/paediatric collaboration (multidisciplinary stroke units), and innovative research into the peculiar risk factors.
• Primary preventative strategies like vaccination and early diagnosis and treatment of the endemic culprit pathogens must be done well.

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