Advances in the Diagnosis and Treatment of Pediatric Arterial Ischemic Stroke

Neurotherapeutics. 2023 Apr;20(3):633-654. doi: 10.1007/s13311-023-01373-5. Epub 2023 Apr 18.


Though rare, stroke in infants and children is an important cause of mortality and chronic morbidity in the pediatric population. Neuroimaging advances and implementation of pediatric stroke care protocols have led to the ability to rapidly diagnose stroke and in many cases determine the stroke etiology. Though data on efficacy of hyperacute therapies, such as intravenous thrombolysis and mechanical thrombectomy, in pediatric stroke are limited, feasibility and safety data are mounting and support careful consideration of these treatments for childhood stroke. Recent therapeutic advances allow for targeted stroke prevention efforts in high-risk conditions, such as moyamoya, sickle cell disease, cardiac disease, and genetic disorders. Despite these exciting advances, important knowledge gaps persist, including optimal dosing and type of thrombolytic agents, inclusion criteria for mechanical thrombectomy, the role of immunomodulatory therapies for focal cerebral arteriopathy, optimal long-term antithrombotic strategies, the role of patent foramen ovale closure in pediatric stroke, and optimal rehabilitation strategies after stroke of the developing brain.

Keywords: Childhood stroke; Pediatric stroke; Sickle cell; Thrombectomy.

Publication types

  • Review

MeSH terms

  • Cerebral Arterial Diseases* / complications
  • Cerebral Arterial Diseases* / diagnosis
  • Cerebral Arterial Diseases* / drug therapy
  • Cerebral Arterial Diseases* / therapy
  • Child
  • Fibrinolytic Agents / administration & dosage
  • Fibrinolytic Agents / therapeutic use
  • Heart Diseases / complications
  • Hematologic Diseases / complications
  • Humans
  • Infections / complications
  • Ischemic Stroke* / diagnosis
  • Ischemic Stroke* / etiology
  • Ischemic Stroke* / rehabilitation
  • Ischemic Stroke* / therapy
  • Mechanical Thrombolysis
  • Neoplasms / complications
  • Thrombolytic Therapy


  • Fibrinolytic Agents