ESO Webinar Report: Paediatric Stroke

The YSPR and ESO Education committees organise a series of educational live webinars covering diverse topics related to stroke. After the live sessions, the recordings are available for all ESO members on the eSTEP platform.

The latest ESO Webinar on 7 November dwelled into the topic of paediatric stroke, focusing on the diagnostic work-up and hyperacute treatment. The session featured presentations from Dr. Maja Steinlin and Dr. Peter Sporns, followed by a Q&A moderated by Dr. Vojtech Novotny and Dr. Anna Bersano.

First, Dr. Steinlin gave a comprehensive introduction to paediatric stroke, emphasising the importance of a designated acute stroke chain for children and collaboration between paediatric and adult stroke physicians. The incidence of paediatric stroke is considerably lower than stroke in adults with 5/100 000/year, and haemorrhagic and ischaemic stroke are almost equally common. Although stroke-related mortality in children is decreasing, morbidity is still high, in contrast to a long-standing misconception that children recover better than adults.

In her talk, Dr. Steinlin presented the most common aetiologies of childhood stroke. Unlike in adults, the top aetiology in children are focal cerebral arteriopathies (FCA) that often have underlying inflammatory pathology. Another frequent cause consists of congenital and acquired cardioembolic conditions. As the presenters highlighted, these patients are the prime candidates for endovascular thrombectomy (EVT), whereas there is ongoing uncertainty about safety and efficacy of EVT in FCA.

As noted by both presenters, the challenge in paediatric stroke is the acute recognition. Due to the low incidence, stroke is rarely suspected, and the frequency of mimics outnumbers that in adults. This results in delayed contact to appropriate care and often prevents patients from receiving hyperacute treatment. The presenters announced MRI+MRA as the preferred imaging modality for children with suspected stroke – however, if MRI is not available within an hour, CT+CTA should be considered.

Finally, Dr. Sporns gave insight into the recent evidence in hyperacute treatment for paediatric stroke. The TIPS case series of children treated with tPA showed a symptomatic intracranial haemorrhage rate equal to adult patients.¹ Considering EVT, the retrospective, multicentre Save ChildS study reported decreased symptom severity at 7 days and median modified Rankin Scale score of 1 at 6 months among children undergoing EVT.² In accordance, the prospective Save ChildS Pro registry observed a better functional outcome at 90 days in children treated with EVT compared to best medical treatment.³ As there are no randomised controlled trials, the current strategies in paediatric hyperacute treatment are based on findings from observational studies and adapted from adult stroke care.

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References

1. Amlie-Lefond C, Shaw DWW, Cooper A, et al. Risk of Intracranial Hemorrhage Following Intravenous tPA (Tissue-Type Plasminogen Activator) for Acute Stroke Is Low in Children. Stroke 2020; 51: 542–548.
2. Sporns PB, Sträter R, Minnerup J, et al. Feasibility, Safety, and Outcome of Endovascular Recanalization in Childhood Stroke: The Save ChildS Study. JAMA Neurol 2020; 77: 25–34.
3. Sporns PB, Bhatia K, Abruzzo T, et al. Endovascular thrombectomy for childhood stroke (Save ChildS Pro): an international, multicentre, prospective registry study. Lancet Child Adolesc Health 2024; S2352-4642(24)00233–5.

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