Acute ischemic stroke in childhood: a comprehensive review

Eur J Pediatr. 2022 Jan;181(1):45-58. doi: 10.1007/s00431-021-04212-x. Epub 2021 Jul 29.


This review provides an updated analysis of the main aspects involving the diagnosis and the management of children with acute ischemic stroke. Acute ischemic stroke is an emergency of rare occurrence in children (rate of incidence of 1/3500 live birth in newborns and 1-2/100,000 per year during childhood with peaks of incidence during the perinatal period, under the age of 5 and in adolescence). The management of ischemic stroke in the paediatric age is often challenging because of pleomorphic age-dependent risk factors and aetiologies, high frequency of subtle or atypical clinical presentation, and lacking evidence-based data about acute recanalization therapies. Each pediatric tertiary centre should activate adequate institutional protocols for the optimization of diagnostic work-up and treatments.Conclusion: The implementation of institutional standard operating procedures, summarizing the steps for the selection of candidate for neuroimaging among the ones presenting with acute neurological symptoms, may contribute to shorten the times for thrombolysis and/or endovascular treatments and to improve the long-term outcome. What is Known: •Acute ischemic stroke has a higher incidence in newborns than in older children (1/3500 live birth versus 1-2/100,000 per year). •Randomized clinical trial assessing safety and efficacy of thrombolysis and/or endovascular treatment were never performed in children What is New: •Recent studies evidenced a low risk (2.1% of the cases) of intracranial haemorrhages in children treated with thrombolysis. •A faster access to neuroimaging and hyper-acute therapies was associated with the implementation of institutional protocols for the emergency management of pediatric stroke.

Keywords: Children; Diagnostic protocol; Neuroimaging; Recanalization therapies; Stroke; Thrombolysis.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Brain Ischemia* / diagnosis
  • Brain Ischemia* / epidemiology
  • Brain Ischemia* / therapy
  • Child
  • Humans
  • Infant, Newborn
  • Intracranial Hemorrhages
  • Ischemic Stroke*
  • Randomized Controlled Trials as Topic
  • Stroke* / diagnosis
  • Stroke* / epidemiology
  • Stroke* / etiology
  • Thrombolytic Therapy
  • Treatment Outcome