Assessment and treatment of stroke in children.

Pediatric stroke remains underrecognized by physicians and families despite efforts to increase awareness. Although the incidence is only 2 to 3 per 100,000 children, stroke is a significant cause of disability in childhood. Ischemic and hemorrhagic strokes occur with approximately equal frequency. How these children should be evaluated and treated has not been well studied, except for randomized, controlled trials performed in children with sickle cell disease. There are consensus guidelines for the evaluation and treatment of ischemic stroke in children but not for hemorrhagic stroke. Extrapolation from the adult stroke literature is problematic in some cases. Children should be evaluated urgently and thoroughly, as multiple stroke risk factors may be present. Treatment includes supportive care geared to reducing metabolic demands in the setting of cerebral ischemia or hemorrhage, as well as targeted therapy depending on the presumed cause of stroke and individual patient risk factors.