Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-13T15:07:34.507Z Has data issue: false hasContentIssue false
  • English
  • Français

Successful treatment of pediatric stroke with recombinant tissue plasminogen activator (rt-PA): a case report and review of the literature

Published online by Cambridge University Press:  21 May 2015

Shirra Cremer ,
Yaniv Berliner ,
David Warren  and
Andrew E. Jones
Shirra Cremer
Affiliation:
Department of Biostatistics and Epidemiology, University of Western Ontario, London, Ont.
Yaniv Berliner
Affiliation:
Division of Emergency Medicine, University of Western Ontario, London, Ont.
David Warren
Affiliation:
Department of Paediatrics, University of Western Ontario, London, Ont.
Andrew E. Jones*
Affiliation:
Division of Emergency Medicine, University of Western Ontario, London, Ont.
*
Emergency Department, Rm. E1-124, London Health Sciences Centre, Victoria Campus, 800 Commissioners Rd. E., London ON N6A 5W9; jonesmd@gmail.com

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Pediatric stroke is a rare disorder with a paucity of evidence-based treatment options, and can result in significant morbidity and mortality. In contrast to adult acute ischemic stroke, where the use of recombinant tissue plasminogen activator (rt-PA) has been studied in several large, randomized clinical trials, no high-level evidence exists for the use of thrombolytics in children with stroke. We report a case of a 15-year-old girl who suffered an acute ischemic stroke and had a dramatic improvement in symptoms following the administration of intravenous rt-PA.

Keywords

pediatric strokeischemic strokethrombolysis
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 6 , November 2008 , pp. 575 - 578
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

References

1.The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N EnglJ Med 1995:333:1581–7.Google Scholar
2.Giroud, M, Lemesle, M, Gouyon, JB, et al.Cerebrovascular disease in children under 16 years of age in the city of Dijon, France: a study of incidence and clinical features from 1985 to 1993. J Clin Epidemiol 1995;48:1343–8.CrossRefGoogle Scholar
3.Lynch, JK, Hirtz, DG, DeVeber, G,et al.Report of the National Institute of Neurological Disorders and Stroke Workshop on Perinatal and Childhood Stroke. Pediatrics 2002;109;116–23CrossRefGoogle ScholarPubMed
4.Kirkham, FJ, Prengler, M, Hewes, DKM, et al.Risk factors for arterial ischemic stroke in children. J Child Neurol 2000;15:299–307.Google Scholar
5.Chabrier, S, Husson, B, Lasjaunias, P, et al.Stroke in childhood: outcome and recurrence risk by mechanism in 59 patients. J Child Neurol 2000;15:290–4.Google Scholar
6.Broderick, JP. Stroke trends in Rochester, Minnesota, during 1945 to 1984. Ann Epidemiol 1993;3:476–9.Google Scholar
7.deVeber, G, MacGregor, D, Curtis, R, et al.Neurologic outcome in survivors of childhood arterial ischemic stroke and sinovenous thrombosis. J Child Neurol 2000;15:316–24.CrossRefGoogle ScholarPubMed
8.Jain, SV, Morton, LD. Ischemic stroke and excellent recovery after administration of intravenous tissue plasminogen activator. Pediatr Neurol 2008;38:126–9.Google Scholar
9.Noser, EA, Felberg, RA, Alexandrov, AV. Thrombolytic therapy in an adolescent ischemic stroke. J Child Neurol 2001;16:286–8).Google Scholar
10.Carlson, MD, Leber, S, Deveikis, J, et al.Successful use of rt-PA in pediatric stroke. Neurology 2001;57:157–8.Google Scholar
11.Thirumalai, SS, Shubin, RA. Successful treatment for stroke in a child using recombinant tissue plasminogen activator. J Child Neurol 2000;15:558.Google Scholar
12.Cognard, C, Weill, A, Lindgren, S, et al.Basilar artery occlusion in a child: “clot angioplasty” followed by thrombolysis. Childs Nerv Syst 2000;16:496–500.Google Scholar
13.Kirton, A, Wong, JH, Mah, J, et al.Successful endovascular therapy for acute basilar thrombosis in an adolescent. Pediatrics 2003;112:248–51.CrossRefGoogle Scholar
14.Gruber, A, Nasel, C, Lang, W, et al.Intraarterial thrombolysis for the treatment of perioperativechildhood cardioembolic stroke. Neurology 2000;54:1684–6.Google Scholar
15.Sungarian, A, Duncan, JA 3rd. Vertebrobasilar thrombosis in children: report of two cases and recommendations for treatment. Pediatr Neurosurg 2003;38:16–20.CrossRefGoogle ScholarPubMed
16.Ho, J, Pacaud, D, Hill, MDet al.Diabetic ketoacidosis and pedi-atric stroke. CMAJ 2005;172(3):327–8.CrossRefGoogle Scholar
7.Monagle, P, Chan, A, Massicotte, P, et al.Antithrombotic therapy in children: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 2004;126:645S–87S.Google Scholar
18.Paediatric Stroke Working Group. Stroke in childhood: clinical guidelines for diagnosis, management and rehabilitation. London (UK): Clinical Effectiveness Evaluation Unit, The Royal College of Physicians; 2004. Available:http:\\www.rcplondon.ac.uk/pubs/books/childstroke/childstroke_guidelines.pdf(accessed 2008 Sept 22)Google Scholar
19.Carpenter, J, Tsuchida, T, Lynch, JK. Treatment of arterial ischemic stroke in children. Expert Rev Neurother 2007;7:383–92.Google Scholar
20.Janjua, N, Nasar, A, Lynch, JK, et al.Thrombolysis for ischemic stroke in children: data from thenationwide inpatient sample. Stroke 2007;6:1850–4CrossRefGoogle Scholar
21.Gabis, LV, Yangala, R, Lenn, NJ.Time lag to diagnosis of stroke in children. Pediatrics 2002;110:924–8.CrossRefGoogle ScholarPubMed
22.Baillargeon, JP, McClish, DK, Essah, PA, et al.Association between the current use of low-dose oral contraceptives and cardiovascular arterial disease: a meta-analysis. J Clin Endocrinol Metab 2005;90:3863–70.Google Scholar
23.Sofronas, M, Ichord, RN, Fullerton, HJ, et al.Pediatric stroke initiatives and preliminary studies: What is known and what is needed? Pediatr Neurol 2006;34:439–45.CrossRefGoogle ScholarPubMed
24.Towards the establishment of standards of practice and the initiation of multi-center, multi-national clinical trials for neonates and children with stroke. June 9 2004 updated Feb 2 2008.Available: http://clinicaltrials.gov/ct2/show/NCT00084292 (accessed 2008 Feb 28).Google Scholar