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Stroke in childhood
  1. F J Kirkham
  1. Neurosciences Unit, Institute of Child Health, The Wolfson Centre, Mecklenburgh Square, London WC1N 2AP, UK
  1. Dr Kirkham. email:FKirkham{at}

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Presentation with stroke is rare in children, with an incidence of 2.6 and 3.1/100 0000 white and black children, respectively.1 Half are haemorrhagic, requiring immediate transfer to a neurosurgical unit in case decompression is required. Traditionally, ischaemic strokes have been considered to be idiopathic and to have a good prognosis, with a low recurrence risk and good recovery of motor function and school performance. They have not been investigated extensively, on the basis that management would not alter. However, there is a significant mortality,1 as well as considerable morbidity and a risk of recurrence, none of which has been adequately defined epidemiologically. In addition, there is now evidence that the neurological outcome could be improved, at least in some subgroups, by appropriate emergency management and, particularly, that recurrence might be preventable. This article proposes essential investigations and management for “good practice” in the current state of knowledge, although further research is clearly required before evidence based guidelines can be produced.

Key messages

  • Children presenting with a focal neurological deficit and any depression of consciousness should be referred urgently to a unit with neurosurgical facilities

  • Most children presenting with stroke have cerebrovascular disease demonstrable with appropriate neuroimaging (magnetic resonance or conventional angiography)

  • Sickle cell disease is one of the most common causes of stroke in childhood, but there may be no clinical manifestations; screening with transcranial Doppler ultrasound may detect large vessel disease in this at risk population

  • Certain patient groups might require specific acute treatment or prophylaxis, although appropriately designed controlled trials are required


A focal neurological deficit lasting more than 24 hours is defined as a stroke if it has a vascular basis, while a similar episode lasting for a shorter period of time is considered to be a transient ischaemic attack. The term “reversible ischaemic neurological deficit” …

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