Pediatric and newborn stroke.

In children, arterial ischemic stroke is more common than hemorrhage. The clinical presentation differs according to age, stroke type, and location. Seizures are more common with ischemia in children, especially in newborns. The presentation of pediatric ischemic stroke is more complex than in adults, so the clinical phenotype of ischemic stroke is modified. Risk factors for ischemic and hemorrhagic stroke include congenital heart disease, blood disorders, vasculopathies, infections (both current and preceding the stroke), and vascular malformations, but often no discernible etiology is determined. Current treatment is based on consensus rather than large, case-controlled studies. There is no strategy for primary prevention of pediatric or newborn stroke except in sickle cell disease. Most clinicians use aspirin for secondary prevention. Transfusion therapy is proven effective for secondary prevention of stroke associated with sickle cell disease. Prospective cohort studies are needed to understand the natural history of pediatric stroke and to determine which individuals are at greatest risk for incident and recurrent stroke. Effective treatment and prevention strategies can only be developed once the causes of stroke in children are understood and populations at greatest risk are identified.