Management of Paediatric Stroke - Challenges and Perspectives from Resource-limited Setting

Elsevier

Available online 19 September 2022, 100996

Seminars in Pediatric NeurologyAbstract

Childhood stroke is not as common as adult stroke, but it is underrecognised the world over. Diagnosis is often delayed due to lack of awareness not only by the lay public but also by emergency and front-line health care workers. Despite the relative rarity of childhood stroke, the impact on morbidity, mortality and the economic burden for families and society is high, especially in poorly resourced settings. The risk factors for stroke in children differ from the adult population where lifestyle factors play a more important role. The developmental aspects of the paediatric cerebral vasculature and haematological maturational biology affects the clinical presentation, investigation, management and outcomes of childhood stroke in a different way compared to adults. The management of childhood stroke is currently based on expert guidelines and evidence extrapolated from adult studies. Hyperacute therapies that have revolutionised the treatment of stroke in adults cannot be easily applied to children at this stage due to the diagnostic delays, diverse risk factors and developmental considerations mentioned above. Much has been achieved in the understanding of genetic, acquired, preventable and recurrent stroke risk factors in the past decade through international collaborative efforts like the International Paediatric Stroke Study (IPSS). Evidence for the prevention and treatment of childhood stroke remains elusive. Even more elusive are relevant and achievable management guidelines for paediatric stroke in resource-limited settings. This narrative review focusses on the current management practices globally, emphasizing the challenges, and gaps in knowledge of paediatric stroke in low- and middle-income countries (LMICs) and other areas with limited resources. Priorities and some potential solutions at national and local level are suggested for these settings.

Keywords

Stroke

paediatric

management

challenges

LMIC

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© 2022 Published by Elsevier Inc.

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