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Question 2: Should thrombolytic agents be used in children presenting with acute ischaemic stroke?
  1. Dhinesh Baskaran1,
  2. Nahin Hussain2
  1. 1Department of Community Paediatrics, Northampton General Hospital, Cliftonville, UK
  2. 2Department of Paediatric Neurology, Leicester Royal Infirmary, Leicester, UK
  1. Correspondence to Dr Dhinesh Baskaran, 87 Leire Street, Leicester LE4 6NU, UK; dhinkeer{at}gmail.com

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Archimedes summary

Structured clinical question

In children (1 month to 18 years) outside the neonatal age range presenting with acute ischaemic stroke (AIS), does thrombolysis help improve neurological outcome? If so, within what time frame does this need to occur in order to be effective?

Outcome of evidence search

Thrombolysis is not clearly of benefit in children presenting with AIS.

Scenario

A previously fit and well 12-year-old girl presents to accident and emergency (A&E) in the middle of the night with an acute-onset left-sided hemiparesis. She was last seen well before bed 3 hours ago. The clinical impression is that she has had a cerebro-vascular accident secondary to an acute ischaemic insult. An urgent out of hours CT head is carried out, which shows ‘hypodense changes in the region of the right middle cerebral artery’. Your A&E colleagues state that they thrombolyse adult patients presenting like this. Do you proceed to thrombolyse this young girl?

Structured clinical question

In children (1 month to 18 years) outside the neonatal age range (patient group) presenting with AIS (condition), does thrombolysis (intervention) help improve neurological outcome (outcome)? If so, within what time frame does this need to occur in order to be effective?

Search strategy

Primary sources

Medline through PubMed was searched using the search strategy given below:

MEDLINE stroke.ti,ab [Limit to: (Age Groups All Child 0–18 years) and (Languages English)] AND (thrombolysis OR thrombolytic AND agent OR alteplase OR …

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