• Hans-Jakob Steiger, Daniel Hänggi, Birgit Assmann, and Bernd Turowski.
• Neurochirurgische Klinik, Universitäts-klinikum der Heinrich-Heine-Universität, Düsseldorf, Germany. Steiger@uni-duesseldorf.de
• Dtsch Arztebl Int. 2010 Dec 1;107(48):851-6.

BackgroundIschemic stroke in children can present with an epileptic seizure or be initially asymptomatic. The median time to diagnosis is 24 hours.MethodsThis review is based on a selective literature search, with additional consideration of published guidelines and the authors' personal experience.ResultsIn Europe and the USA, the combined incidence of ischemic and hemorrhagic stroke in childhood is 2.5 to 10 per 100 000 children per year. 40% of ischemic strokes in childhood occur after an infectious illness or in association with a congenital heart defect, sickle-cell anemia, or a coagulopathy. Arterial dissection and chronic, progressive cerebral arteriopathies, particularly moyamoya disease, each account for up to 10% of childhood strokes. Magnetic resonance imaging can be used to demonstrate infarcts and to display the perfusion of ischemic areas and the surrounding brain tissue; arterial and venous occlusions can be defined more precisely. Children with arterial dissection, vasculitis, and para-infectious cerebral ischemia should be treated empirically, with medications and supportive care, according to the treatment plans developed for adults. For patients with moyamoya disease, surgical revascularization with extra-intracranial bypass techniques is recommended.DiscussionThe current data provide an inadequate evidence base for the treatment of stroke in children. Potential revascularization or thrombolysis must be discussed individually in each case. For the treatment of temporary, para-infectious cerebral ischemia, hemodynamic optimization is an available option. Better evidence is needed regarding the surgical treatment of moyamoya disease.

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