Author(s): Ganguly R.; Healey A.; Mallucci C.; Kumar R.; Chandran A.; Putheran M.
Source: Developmental Medicine and Child Neurology; Dec 2017; vol. 59 ; p. 35
Publication Date: Dec 2017
Publication Type(s): Conference Abstract
Available at Developmental Medicine and Child Neurology – from Wiley Online Library Full Collection
Abstract:Patients with hyperacute arterial ischaemic stroke (AIS) presenting within 6 hours of onset are eligible for interventions including mechanical thrombectomy. Mechanical thrombec-tomy is an effective treatment for adults with hyperacute stroke. The Royal College of Paediatrics and Child Health (RCPCH) Stroke in Childhood 2017 guidelines in the United Kingdom encourages consideration of mechanical thrombec-tomy in suitable children with AIS. We present our recent experience with two children treated with mechanical thrombectomy for AIS. Patient 1: 4 year old boy, recent varicella infection, presented to our emergency department with acutely obtunded (GCS 5) 20 minutes preceding attendance. A CT head at 40 minutes after onset showed hyperdense signal in the basilar artery without infarction. MRI brain at 3 hours confirmed basilar artery thrombus with pontine ischaemia without established infarct. Mechanical thrombectomy at 5 hours after onset resulted in recovery of fresh thrombus and re-established patency. He was extubated after 2 days, and discharged home after 30 days with mild left ataxic signs. CSF Varicella PCR was positive. Patient 2: 10 year old boy, background congenital cardiac problems, presented to his local hospital 55 miles away with acute aphasia and severe hemiparesis. PedNIHSS 16. CT head at 3 hours after onset demonstrated left middle cerebral artery thrombus without infarction. MRI brain at 9.5 hours demonstrated diffusion restriction limited to basal ganglia. Trans-portation to our centre and mechanical thrombectomy were achieved within 10 hours, with two clots removed. There was immediate recovery of speech and motor improvement. He was discharged home after 35 days. He has mild right hemi-plegia with normal speech. Conclusion: We present the challenges and opportunities in delivering mechanical thrombectomy for hyperacute stroke treatment in children. There is a need for development of regional paediatric hyperacute stroke services to implement accessible, safe and effective mechanical thrombectomy in a timely fashion.