stroke

Question 1

most common risk factors for arterial ischemic stroke (AIS) in children

Answer 1

congenital heart disease
acquired heart disease
arteriopathies ( transient cerebral arteriopathy, arterial dissection, moyamoya syndrome, vasculitis)
infection
hematologic (sickle cell, prothrombotic states)
metabolic
oncologic

Question 2

risk factors for neonatal strokes

Answer 2

cardiac disorders
hypercoaguable conditions
infections
trauma
medications
maternal disorders
perinatal asphyxia

Question 3

in the neonate, stroke most commonly presents with

Answer 3

focal seizure

other s/s
decreased responsiveness
focal weakness

Question 4

for strokes, children are more likely to present with

Answer 4

focal neuro deficits such as hemiparesis
aphasia
visual disturbances
headache

Question 5

in neonates and children, _____ are the most common presenting sign of sinus venous thrombosis (SVT)

Answer 5

seizures

Question 6

when is Sinus venous thrombosis (SVT) most commonly seen?

Answer 6

more than half present in the first 6 months of life with the neonatal period being the most common

Question 7

if a carotid or vertebral dissection or SVT is a consideration, _______, should be performed (imaging)

Answer 7

CTA/MRA or venogram

Question 8

what imaging is useful to evaluate for metabolic causes of stroke

Answer 8

MR spectroscopy

Question 9

AHA class 1 stroke recommendations

Answer 9

supportive management:
supplementing coagulation factors in coag disorders

Replacing platelets in those with intracranial hemorrhage

ventricular drainage for hydrocephalus

Question 10

AHA class II stroke recommendations

Answer 10

treat dehydration 
treat anemia
use rehab sources
give folate or vit B to those with a MTHFR mutation and an abnormal homocysteine level 
evacuate hematoma that elevates ICP

Question 11

General stroke management

Answer 11

Support ABCs
Neuroprotection:
-prevent fever
-maintain normoglycemia
-maintain normovolemia
-HOB flat to promote cerebral perfusion unless concern for ICP
ASA 3-5 mg/kg/day for recurrent stroke prevention (proven to be as effective as warfarin in kids)
- Consider risk of Reye syndrome first - at risk following varicella and other viral infections.

for extracranial dissection or cardioembolic stroke - anticoagulation with heparin or low molecular weight heparin can be initiated acutely..

Question 12

do you give TPA in children

Answer 12

it is increasing in use but it is not FDA approved for use in children

Question 13

imaging for dissection

Answer 13

CTA or MRA