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„Childhood stroke“

Was macht den Schlaganfall beim Kind besonders?

Childhood stroke

What are the special features of childhood stroke?

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Zusammenfassung

Der arteriell ischämische Schlaganfall des Kindes – „childhood stroke“ – unterscheidet sich in wesentlichen Aspekten vom Schlaganfall des Erwachsenen. Er ist selten, bei Laien und Ärzten oft wenig bekannt und wird, aufgrund einer Fülle prozentual wahrscheinlicherer Differenzialdiagnosen („stroke mimics“) und in der Fläche noch wenig etablierter Versorgungsstrukturen, häufig erst jenseits der hyperakuten Phase diagnostiziert. Die möglichen Therapien im Kindesalter sind zumeist off-label. Erfahrungen zu den in der Erwachsenenneurologie etablierten Akuttherapien der Thrombolyse und mechanischen Thrombektomie sind in der Pädiatrie noch begrenzt und basieren auf Fallberichten/-serien. Die ätiologische Abklärung ist aufgrund der Fülle der zu bedenkenden Risikofaktoren aufwendig. Bei einem Großteil der Patienten können mindestens zwei Risikofaktoren nachgewiesen werden. Das individuelle Risikoprofil eines jeden Patienten ist entscheidend für die Akuttherapie und Sekundärprophylaxe und beeinflusst das individuelle Outcome. Für die Integration des Kindes in sein schulisches, später berufliches und soziales Umfeld sind neben dem klinisch neurologischen Outcome auch die Auswirkungen des Schlaganfalls auf Kognition und Verhalten entscheidend.

Abstract

Childhood arterial ischemic stroke differs in essential aspects from adult stroke. It is rare, often relatively unknown among laypersons and physicians and the wide variety of age-specific differential diagnoses (stroke mimics) as well as less established care structures often lead to a considerable delay in the diagnosis of stroke. The possible treatment options in childhood are mostly off-label. Experiences in well-established acute treatment modalities in adult stroke, such as thrombolysis and mechanical thrombectomy are therefore limited in children and only based on case reports and case series. The etiological clarification is time-consuming due to the multitude of risk factors which must be considered. Identifying each child’s individual risk profile is mandatory for acute treatment and secondary prevention strategies and has an influence on the individual outcome. In addition to the clinical neurological outcome the residual neurological effects of stroke on cognition and behavior are decisive for the integration of the child into its educational, later professional and social environment.

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Danksagung

Wir danken Herrn PD Dr. Marwan El Koussy, Universitätsinstitut für Diagnostische und Interventionelle Neuroradiologie, Universitätsspital Inselspital Bern, für die freundliche Überlassung des Bildmaterials.

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Authors and Affiliations

  1. Pädiatrische Neurologie und Entwicklungsneurologie LMU Zentrum – iSPZ Hauner, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital der Universität München, Lindwurmstr. 4, 80337, München, Deutschland

    L. Gerstl, M. V. Bonfert & F. Heinen

  2. Abteilung für Pädiatrische Hämostaseologie, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital der Universität München, München, Deutschland

    M. Olivieri

  3. Abteilung für Spezielle Pädiatrische Intensivmedizin und Notfallmedizin, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital der Universität München, München, Deutschland

    T. Nicolai & M. Olivieri

  4. Abteilung für Neuropädiatrie, Universitätsklinik für Kinderheilkunde, Inselspital Bern, Bern, Schweiz

    M. Steinlin

  5. Neurologische Klinik und Poliklinik & Deutsches Schwindel- und Gleichgewichtszentrum DSGZ, Campus Großhadern, Klinikum der Universität München, Koordinationszentrum NEVAS, München, Deutschland

    M. Dieterich & C. Adamczyk

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  1. L. Gerstl
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  2. M. V. Bonfert
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  3. T. Nicolai
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  4. M. Dieterich
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  5. C. Adamczyk
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  6. F. Heinen
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  7. M. Olivieri
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  8. M. Steinlin
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Corresponding author

Correspondence to L. Gerstl.

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Interessenkonflikt

L. Gerstl, M.V. Bonfert,T. Nicolai, M. Dieterich, C. Adamczyk, F. Heinen, M. Olivieri und M.Steinlin geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Gerstl, L., Bonfert, M.V., Nicolai, T. et al. „Childhood stroke“. Nervenarzt 88, 1367–1376 (2017). https://doi.org/10.1007/s00115-017-0435-7

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