Management Pediatric Stroke
Dhamirah Sakinah Binti Makmon
10-5-75
Management of Paediatric Stroke
The treatment of ischemic stroke is involve both initial treatment of acute stroke to preserve neurological function and continuous treatment to prevent recurrent stroke which occurs in 10% and 25% of children with stroke. Efforts to prevent a first stroke are also important for children with high risk conditions such as congenital heart disease.
For all type of perinatal stroke, supportive treatment is a must. The supportive measures for acute ischemic stroke (AIS) should include control of fever, maintenance of normal oxygenation, control of systemic hypertension and normalization of serum glucose. It is also reasonable to treat dehydration and anemia in children with stroke.
In individuals with intracerebral haemorrhage (ICH) , the markedly low platelet counts should be corrected. Replacement of the deficient coagulation factors should be given to neonates with ICH. For individuals with vitamin K-dependent coagulation disorder, Vitamin K should be administer. Higher doses maybe required in neonates with factor defiicencies resulting from maternal medications. Patients who develop hydrocephalus after an ICH should undergo ventricular drainage and later shunting if significant hydrocephalus persists.
For neurological dysfunction, the use of rehabilitation and ongoing physical therapy is reasonable. It is also reasonable to give folate and vitamin B to individual with an MTHFR mutation in an effort to normalize homocysteine levels. For one that have intraparenchymal brain hematoma, evacuation of the hematoma can be done to reduce very high intracranial pressure. In selected neonates with severe thrombophilic disorder, multiple cerebral or systemic emboli, or propagating cerebral venous sinus thrombosis (CVST) despite supportive therapy, anticoagulation with low molecular weight heparin (LWPH) or unfractioned heparin (UFH) may be considered.
For long-term anticoagulation of children with a
10-5-75
Management of Paediatric Stroke
The treatment of ischemic stroke is involve both initial treatment of acute stroke to preserve neurological function and continuous treatment to prevent recurrent stroke which occurs in 10% and 25% of children with stroke. Efforts to prevent a first stroke are also important for children with high risk conditions such as congenital heart disease.
For all type of perinatal stroke, supportive treatment is a must. The supportive measures for acute ischemic stroke (AIS) should include control of fever, maintenance of normal oxygenation, control of systemic hypertension and normalization of serum glucose. It is also reasonable to treat dehydration and anemia in children with stroke.
In individuals with intracerebral haemorrhage (ICH) , the markedly low platelet counts should be corrected. Replacement of the deficient coagulation factors should be given to neonates with ICH. For individuals with vitamin K-dependent coagulation disorder, Vitamin K should be administer. Higher doses maybe required in neonates with factor defiicencies resulting from maternal medications. Patients who develop hydrocephalus after an ICH should undergo ventricular drainage and later shunting if significant hydrocephalus persists.
For neurological dysfunction, the use of rehabilitation and ongoing physical therapy is reasonable. It is also reasonable to give folate and vitamin B to individual with an MTHFR mutation in an effort to normalize homocysteine levels. For one that have intraparenchymal brain hematoma, evacuation of the hematoma can be done to reduce very high intracranial pressure. In selected neonates with severe thrombophilic disorder, multiple cerebral or systemic emboli, or propagating cerebral venous sinus thrombosis (CVST) despite supportive therapy, anticoagulation with low molecular weight heparin (LWPH) or unfractioned heparin (UFH) may be considered.
For long-term anticoagulation of children with a