Urs Fischer talks to BLearning Neuro at ESMINT 2019 (European Society of Minimally Invasive Neurological Therapy; 4–6 September 2019; Nice, France) about some of the differences regarding symptoms and treatment of stroke in children and adults.
Fischer says that stroke in children is a “huge challenge” because the “vast majority” of people don’t expect that children can have strokes. Fischer notes while some symptoms are the same as in adults, such as hemiparesis or speech problems, children who have a stroke often mimic other diseases such as a migraine or seizure.
Fischer notes that there are currently no randomised trials in how to treat children with acute ischaemic stroke. He says that this is understandable because “who would randomise their son or daughter into a trial if we have such a strong evidence in adults that thrombolysis or thrombectomy works”.
The aetiology of stroke is different in adults and children. Children can have emboli from the heart as seen in adults, but “most often they have an inflammation of the vessel wall”, also called a vasculopathy. Thus “we cannot conclude that the treatment approaches we have in adults are the same also in children”, he adds.
Fischer says that the only possible way to compare efficacy of treatment between adults and children is through observational data. He outlines his own data which compared the outcome of children receiving thrombolysis and thrombectomy with young adults. While complication rates and mortality were “more or less the same”, Fischer’s data found that for intravenous thrombolysis children were often “coming too late for treatment”.
Fischer concludes that in the future “what we have to aim for is individualised treatment decisions based on imaging information and clinical data”.