ABSTRACT: Purpose of Review: This article reviews risk factors, recurrence risk, evaluation, management, and outcomes of arterial ischemic stroke in children and young adults.
Recent Findings: The risk for recurrence and mortality appear to be low for neonatal and childhood stroke. Most children have relatively mild deficits, but those who have greater neurologic deficits, poststroke epilepsy, or strokes early in life are at risk for lower overall cognitive function. Stroke recurrence and long-term mortality after stroke in young adults are greater than originally thought. Cognitive impairments, depression, and anxiety are associated with higher levels of poststroke unemployment and represent targets for improved poststroke care. Poststroke care in young adults involves more than medical management. Self-reported memory and executive function impairments may be more severe than what is detected by objective measures. Assessment of possible cognitive impairments and appropriate management of psychological comorbidities are key to maximizing the long-term functional outcome of stroke survivors.
Summary: Childhood and young adult stroke survivors survive for many more years than older patients with stroke. To ensure that these survivors maximize the productivity of their lives, neurologists must not only optimize medical management but also recognize that impairments in cognition and mood may be remediable barriers to long-term functional independence.
Address correspondence to Dr Warren D. Lo, Nationwide Children’s Hospital, 700 Children’s Dr, EDU 582, Columbus, OH 43205, firstname.lastname@example.org.
Relationship Disclosure: Dr Lo receives research/grant support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (5R01HD068345, 1R01HD074574, R01HD083384) and the National Institute of Neurological Disorders and Stroke (U10NS086484, U54 NS065705) and receives publishing royalties from Springer. Dr Kumar serves on the medical advisory board of Bayer Corporation and receives research/grant support from the Hemostasis and Thrombosis Research Society (HTRS Mentored Research Award) and the International Society on Thrombosis and Haemostasis.
Unlabeled Use of Products/Investigational Use Disclosure: Drs Lo and Kumar discuss the unlabeled/investigational use of antithrombotic and thrombolytic agents in children with stroke.