Response to Letter by Bhatt
We thank Dr Bhatt for his interesting comment. We agree that rapid diagnosis enabling thrombolytic treatment of basilar artery occlusion (BAO) is particularly challenging in very young children. This is in line with the fact that no child with BAO younger than 6 years of age has been reported to be treated with thrombolysis except for the case of Bhatt et al.
The increasing awareness of pediatric stroke and the more frequent use of modern imaging techniques such as perfusion CT, perfusion and diffusion-weighted MRI, CT angiography, and MR angiography have the potential to improve the early differentiation between BAO and stroke mimics such as seizures and to reduce the time from symptom onset to treatment.
The natural history of BAO in children is not well-known because the available data are limited. Early recanalization after thrombolysis was regarded by Mattle and Linsberg to be the conditio sine qua non for good outcome (defined by a modified Rankin Scale score of 0 to 2) in adults with BAO.1 Furthermore, Rha and Saver showed in a systematic analysis that recanalization significantly improved the likelihood of a good clinical outcome and reduced mortality in adult stroke.2 It seems thus likely that early thrombolytic treatment will also improve the clinical outcome in childhood stroke due to BAO.
Considering the small number in single institutions and the wide range of age of children with stroke, multicenter research including large prospective registries and randomized controlled trials are needed to improve our limited knowledge in the challenging field of childhood stroke.