33 - Pediatric Cerebrovascular Disorders

Summary

The childhood stroke is classified as either hemorrhagic or ischemic. Hemorrhagic infarctions are either subarachnoid or intraparenchymal. No historical feature distinguishes ischemic from hemorrhagic stroke. However, nausea, vomiting, headache, and a depressed level of consciousness are more common in hemorrhagic strokes. Subarachnoid hemorrhage (SAH) generally presents with a sudden onset of severe headache, nausea, vomiting, meningismus, and photophobia. Ischemic infarctions are thrombotic (arterial or venous) or embolic (arterial). Seizures are a presenting symptom of ischemic stroke in approximately 20% of patients. The sudden development of focal neurological deficits, headache, seizure, and altered consciousness are typical manifestations of childhood stroke. Selected historical information helps to determine the etiology of stroke. An emergent head computerized tomography (CT) scan may help to determine whether the stroke is hemorrhagic or ischemic and to guide further diagnostic evaluations. Aspirin is used especially in children who are at risk of developing recurrent stroke.