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(Stroke. 2009;40:801.)
© 2009 American Heart Association, Inc.

Original Contributions

Thrombolysis in Childhood Stroke

Report of 2 Cases and Review of the Literature

Marcel Arnold, MD; Maja Steinlin, MD; Andreas Baumann, MD; Krassen Nedeltchev, MD; Luca Remonda, MD; Sonya Jourdan Moser, MD; Marie-Luise Mono, MD; Gerhard Schroth, MD; Heinrich P. Mattle, MD Ralf W. Baumgartner, MD

From the Departments of Neurology (M.A., A.B., K.N., M.-L.M., H.P.M.), Pediatrics (M.S., S.J.M.), and Neuroradiology (L.R., G.S.), University Hospital of Berne, Inselspital, University of Berne, Berne, Switzerland; and the Department of Neurology (R.W.B.), University Hospital of Zurich, Zurich, Switzerland.

Correspondence to Marcel Arnold, MD, University Hospital Bern, Department of Neurology, Freiburgstrasse, CH-3010 Bern, Switzerland. E-mail marcel.arnold{at}insel.ch

Background and Purpose— No controlled, randomized trial has investigated whether intravenous, intra-arterial (IAT), or mechanical thrombolysis is beneficial in children with ischemic stroke. We report 2 children who underwent IAT for acute ischemic stroke and include them in a review about intravenous thrombolysis, IAT, and mechanical thrombolysis for childhood stroke.

Methods— We searched in MEDLINE and EMBASE for studies that reported on treatment of childhood stroke with intravenous thrombolysis, IAT, or mechanical thrombolysis in the presence of occlusion of the basilar artery, sphenoidal, or insular middle cerebral artery. To be included in this review, the following findings had to be reported: (1) stroke severity at presentation; (2) cerebral imaging findings before thrombolysis; (3) time to treatment; (4) dose of the thrombolytic agent; (5) pre- and postinterventional angiographic findings in IAT; and (6) outcome assessed at hospital discharge or within 12 months after thrombolysis.

Results— Adequate data were available in 17 children (including our 2 own cases) who underwent intravenous thrombolysis (n=6), IAT (n=10), or mechanical thrombolysis (n=1). No symptomatic intracranial hemorrhage occurred, but 2 asymptomatic intracranial hemorrhages were present. Sixteen children (94%) survived, and 12 (71%) had a good outcome (modified Rankin Scale score 0 or 1).

Conclusions— The available data about thrombolysis in pediatric stroke are limited. They suggest that this treatment may be beneficial in children with ischemic stroke. Controlled, randomized trials are needed to determine whether thrombolysis is useful in childhood stroke.

Key Words: acute stroke • stroke in children • thrombolysis

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