Rare but happens.
- ?brachial plexus injury,
- Todd’s paralysis,
- “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.
Cardiac (esp surgery, right to left shunt)
Sickle cell – esp anaemia, acute chest syndrome, HbS or HbS/Beta thal
Liver/kidney disease (secondary prothrombotic tendency)
VZV within 1yr, enteroviruses, HIV.
Vasculitis – Moya Moya (peaks at 5-9yr else adulthood), SLE, other
High flow O2, 10ml/kg saline
Imaging within 1hr.
BP – avoid high and low? Cf adults
Monitor for RICP
Treat with aspirin.
- CTA/MRA at time of CT/MRI
- (Transcranial doppler in sickle cell- via temporal bony window)
- Hbopathy screen
- Lupus anticoagulant, Anti cardiolipin ab (ACLA), consider beta 2GP1
- Alpha galactosidase
- Lipoprotein A – marker for CVS disease, genetic.