Childhood stroke affects several hundred children in the UK each year and is in the top 10 causes of childhood death. Many children have another medical condition such as congenital heart disease or sickle cell disease. At least 10% of people with sickle cell disease will have a stroke during childhood. The physical, emotional, and social effects of stroke result in long lasting consequences both for the affected young person, their family, and society as a whole.

The working party that developed this guideline was initiated by the British Paediatric Neurology Association and worked in collaboration with the Royal College of Physicians Intercollegiate group which has produced stroke guidelines for adults. The paediatric stroke guidelines¹ address the diagnosis, investigation, initial management, and rehabilitation of acute arterial ischaemic stroke in children beyond the neonatal period. Many aspects of rehabilitation are also relevant to children with other causes of stroke (for example, cerebral venous infarction, neonatal stroke, intracranial haemorrhage). However, the recommendations for acute management underline the importance of distinguishing between ischaemic and other categories of stroke. The scope includes the organisation of services; only clinical practice recommendations are included in this summary.

KEY PRACTICE RECOMMENDATIONS

Primary prevention

• Children with haemoglobin SS or Sβ° thalassaemia should be screened yearly from the age of 3 years for internal carotid artery or middle cerebral artery velocity > 200 cm/s using appropriately trained personnel and transcranial Doppler ultrasound [grade B]

• Children with sickle cell disease who have internal carotid artery/middle cerebral artery velocity > 200 cm/s should be offered long term blood transfusion [grade B]

Initial investigations

• Cross sectional brain imaging is mandatory in children presenting with clinical stroke [grade C]

• Brain magnetic resonance imaging (MRI) is recommended for the investigation of children presenting with clinical stroke [grade C]

• Brain MRI should be undertaken as soon as possible after presentation. If …