Thrombolysis in Childhood Stroke : Report of 2 Cases and Review of the Literature

• Published in: Stroke (1970) 2009-03, Vol.40 (3), p.801-807
• Main Authors: ARNOLD, Marcel, STEINLIN, Maja, BAUMANN, Andreas, NEDELTCHEV, Krassen, REMONDA, Luca, JOURDAN MOSER, Sonya, MONO, Marie-Luise, SCHROTH, Gerhard, MATTLE, Heinrich P, BAUMGARTNER, Ralf W
• Format: Article
• Language: English
• Subjects: Angiography, Digital Subtraction; Aphasia - etiology; Biological and medical sciences; Cerebral Angiography; Child; Fatal Outcome; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - adverse effects; Fibrinolytic Agents - therapeutic use; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Hemiplegia - etiology; Humans; Infarction, Middle Cerebral Artery - etiology; Infarction, Middle Cerebral Artery - pathology; Infusions, Intra-Arterial; Injections, Intravenous; Male; Medical sciences; Nervous system (semeiology, syndromes); Neurology; Streptococcal Infections - complications; Stroke - etiology; Stroke - therapy; Thrombolytic Therapy; Tomography, X-Ray Computed; Vascular diseases and vascular malformations of the nervous system; Vertebrobasilar Insufficiency - therapy
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.108.529560

No controlled, randomized trial has investigated whether intravenous, intra-arterial (IAT), or mechanical thrombolysis is beneficial in children with ischemic stroke. We report 2 children who underwent IAT for acute ischemic stroke and include them in a review about intravenous thrombolysis, IAT, and mechanical thrombolysis for childhood stroke. We searched in MEDLINE and EMBASE for studies that reported on treatment of childhood stroke with intravenous thrombolysis, IAT, or mechanical thrombolysis in the presence of occlusion of the basilar artery, sphenoidal, or insular middle cerebral artery. To be included in this review, the following findings had to be reported: (1) stroke severity at presentation; (2) cerebral imaging findings before thrombolysis; (3) time to treatment; (4) dose of the thrombolytic agent; (5) pre- and postinterventional angiographic findings in IAT; and (6) outcome assessed at hospital discharge or within 12 months after thrombolysis. Adequate data were available in 17 children (including our 2 own cases) who underwent intravenous thrombolysis (n=6), IAT (n=10), or mechanical thrombolysis (n=1). No symptomatic intracranial hemorrhage occurred, but 2 asymptomatic intracranial hemorrhages were present. Sixteen children (94%) survived, and 12 (71%) had a good outcome (modified Rankin Scale score 0 or 1). The available data about thrombolysis in pediatric stroke are limited. They suggest that this treatment may be beneficial in children with ischemic stroke. Controlled, randomized trials are needed to determine whether thrombolysis is useful in childhood stroke.