ACUTE ISCHEMIC STROKE IN CHILDREN: UPDATED DIAGNOSIS AND MANAGEMENT ACCORDING TO THE 2026 AHA/ASA GUIDELINES
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Abstract
Acute pediatric stroke is a neurological emergency associated with substantial mortality and severe long-term neurological sequelae. The 2026 AHA/ASA guidelines represent a major milestone by providing, for the first time, pediatric-specific recommendations centered on three key domains: early recognition, neuroimaging, and reperfusion therapy. During the initial assessment, adult stroke screening tools such as FAST demonstrate limited sensitivity in children, whereas the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) is useful in hospital settings but remains underutilized in the community. Prehospital emergency medical services play a pivotal role in reducing treatment delays through early recognition, pre-notification, and timely transport to appropriate stroke centers. MRI/MRA is preferred because of its superior ability to identify ischemic lesions and distinguish stroke mimics; however, CT/CTA remains essential when rapid implementation is required to avoid treatment delays. Updated recommendations expand indications for reperfusion therapy, including consideration of intravenous thrombolysis within the first 4.5 hours and endovascular therapy in selected cases based on imaging assessment. Optimal supportive care remains fundamental to improving neurological outcomes in children with acute stroke.
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Keywords
pediatric stroke, early recognition, reperfusion therapy
References
2. Powers WJ, Rabinstein AA, Ackerson T et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019;50(12):e344–e418. https://doi.org/10.1161/STR.0000000000000211
3. Berge E, Whiteley W, Audebert H et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J 2021;6(1):I–LXII. https://doi.org/10.1177/2396987321989865
4. Ferriero DM, Fullerton HJ, Bernard TJ et al. Management of stroke in neonates and children: a scientific statement from the American Heart Association/American Stroke Association. Stroke 2019;50(3):e51–e96. https://doi.org/10.1161/str.0000000000000183
5. DeVeber GA, Kirton A, Booth FA et al. Epidemiology and outcomes of arterial ischemic stroke in children: the Canadian Pediatric Ischemic Stroke Registry. Pediatr Neurol 2017;69:58–70. https://doi.org/10.1016/j.pediatrneurol.2017.01.016
6. Mallick AA, Ganesan V, Kirkham FJ et al. Childhood arterial ischemic stroke incidence, presenting features, and risk factors: a prospective population-based study. Lancet Neurol 2014;13(1):35–43. https://doi.org/10.1016/s1474-4422(13)70290-4
7. Rivkin MJ, deVeber G, Ichord RN et al. Thrombolysis in Pediatric Stroke Study. Stroke 2015;46(3):880–885. https://doi.org/10.1161/strokeaha.114.008210
8. Đỗ Thuý Hằng, Cao Vũ Hùng, Lê Đình Công, Đỗ Thị Thanh Hương. Đặc điểm lâm sàng và hình ảnh học sọ não của bệnh nhồi máu não ở trẻ em tại Bệnh viện Nhi Trung ương. Tạp Chí Nghiên cứu Y học 2023;169(8), 164-172. https://doi.org/10.52852/tcncyh.v169i8.1831