Rare but happens.

Differential:

• ?brachial plexus injury,
• Todd’s paralysis,
• migraine,
• “alternating hemiplegia of childhood” (developmental regression)

Can be due to arterial or venous occlusion.  50:50 in kids cf adults (80% infarct). Haemorrhagic can be due to rupture into infarct.

Presents with focal signs, headache, seizures most commonly. Else dysphasia, vomiting!, confusion. Fever! Acute signs often lacking or fluctuant cf history!  FAST criteria only 78% sensitive. 

NIH stroke severity scale has paeds version. 

Risk factors

Black/Asian

Cardiac (esp surgery, right to left shunt)

Sickle cell – esp anaemia, acute chest syndrome, HbS or HbS/Beta thal

Thrombophilia

Liver/kidney disease (secondary prothrombotic tendency)

VZV within 1yr, enteroviruses, HIV.

Vasculitis – Moya Moya (peaks at 5-9yr else adulthood), SLE, other

Cocaine, glue.

Marfans, homocysteinuria, Fabry’s disease, Neurofibromatosis

Cancer, radiotherapy

Hypoglycaemia. 

Management

High flow O2, 10ml/kg saline 

Imaging within 1hr. 

BP – avoid high and low? Cf adults

Monitor for RICP

Treat with aspirin.

Tests

• CTA/MRA at time of CT/MRI
• Echo
• (Transcranial doppler in sickle cell- via temporal bony window)
• Hbopathy screen
• Cholesterol
• Lupus anticoagulant, Anti cardiolipin ab (ACLA), consider beta 2GP1
• Homocysteine
• Alpha galactosidase
• Lipoprotein A – a kind of LDL but induces vascular inflammation, so a marker for CVS disease 

[RCPCH guideline May 2017]