Aggiornamento
Stroke ischemico e terapie iperacute nel bambino e nell’adolescente visti da un Pronto Soccorso pediatrico e da uno dell’adulto
Ischemic stroke and hyperacute therapies in children and adolescents examined in paediatric and in adult emergency departments
Alessandro Agostino Occhipinti1, Ferruccio Degrassi1, Mario Diplomatico2, Alberto Di Mascio1, Paola Caruso1, Egidio Barbi1,3, Giorgio Cozzi3
1Università di Trieste
2AORN San Giuseppe Moscati, Avellino
3IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
Marzo 2022 - pagg. 153 -160 | DOI: 10.53126/MEB41153
Abstract
The use of hyperacute therapies, such as thrombolysis and mechanical thrombectomy, has revolutionized the care of adult patients with arterial ischemic stroke. In this context, one of the most effective Diagnostic Therapeutic Assistance Pathways (PDTAs) in Italy, and particularly in the Friuli Venezia Giulia Region, describes the care received by the patient with cerebral stroke, who for epidemiological reasons is an adult patient. Drawn up in 2015 and operational in Trieste and Udine, it represented a fundamental step forward in medicine as it dramatically reduced mortality and disability in stroke patients. The effectiveness reported in the literature of the use of hyperacute therapies in children with ischemic stroke requires reflection on the management of such children so that they can take advantage of these therapeutic possibilities. The paper presents 3 cases with a brief comment each that suggests some reflections on stroke treatment in paediatrics and on the possibilities of treatment similar to that of adults.
Riassunto
Sebbene lo stroke sia un evento raro nei bambini rimane una condizione caratterizzata da mortalità fino a un terzo dei casi e gravata in più della metà dei casi da esiti a distanza quali deficit motori, epilessia e disturbi psichici in grado di impattare gravemente sulla qualità della vita e l’autonomia nell’età adulta. In questo lavoro descriviamo, a partire da 3 casi clinici, i diversi approcci terapeutici secondo le recenti linee guida internazionali e al tempo stesso proponiamo spunti di riflessione sulla reale possibilità di estendere il modello terapeutico che ha modificato la storia naturale dello stroke nell’adulto (trombolisi e trombectomia meccanica) ai reparti di emergenza pediatrica.
Classificazione MeSH
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Bibliografia
1. Arias E, Anderson RN, Kung HC, Murphy SL, Kochanek KD. Deaths: final data for 2001. Natl Vital Stat Rep 2003;52(3):1-115.
2. Antonaglia V, Florio MC, Eleopra R, et al. (eds); Regione Friuli Venezia Giulia, Gruppo di Lavoro Regionale “Rete Ictus”. Percorso Assistenziale per la presa in carico del paziente con ictus cerebrale. Agosto 2015.
3. Peterson RK, Williams TS, McDonald KP, Dlamini N, Westmacott R. Cognitive and academic outcomes following childhood cortical stroke. J Child Neurol 2019;34(14):897-906. doi: 10.1177/0883073819866609.
4. Souto Silva R, Rodrigues R, Reis Monteiro D, et al. Acute ischemic stroke in a child successfully treated with thrombolytic therapy and mechanical thrombectomy. Case Rep Neurol 2019;11(1):47-52. doi: 10.1159/ 000496535.
5. Diplomatico M, Barbi E. Letter by Diplomatico and Barbi regarding article, “Management of stroke in neonates and children: a scientific statement from the American Heart Association/American Stroke Association”. Stroke 2019;50(10):e294. doi: 10.1161/ STROKEAHA.119.025698.
6. Mackay MT, Chua ZK, Lee M, et al. Stroke and nonstroke brain attacks in children. Neurology. 2014 Apr 22;82(16):1434-40. doi: 10.1212/WNL.0000000000000343.
7. Manno C, Disanto G, Bianco G, et al. Outcome of endovascular therapy in stroke with large vessel occlusion and mild symptoms. Neurology 2019;93(17):e1618-26. doi: 10. 1212/WNL.0000000000008362.
8. deVeber G, Kirkham F, Shannon K, et al. Recurrent stroke: the role of thrombophilia in a large international pediatric stroke population. Haematologica 2019;104(8):1676-1. doi: 10.3324/haematol.2019.234666.
9. Iacono A, Guiducci C, Turlà G, Renzelli C, Ricciardelli P, Marchetti F. Lo stroke ischemico nel bambino. Medico e Bambino 2018;37(7):425-31.
10. Mackay M, Lee M, Yock-Corrales A, et al. Differentiating arterial ischaemic stroke from migraine in the paediatric Emergency Department. Dev Med Child Neurol 2018;60 (11):1117-22. doi: 10.1111/dmcn.13772.
11. Yock-Corrales A, Mackay MT, Mosley I, Maixner W, Babl FE. Acute childhood arterial ischemic and hemorrhagic stroke in the Emergency Department. Ann Emerg Med 2011;58(2):156-63. doi: 10.1016/j.annemergmed.2010.10.013.
12. Palmieri A, Savasta S, Zampogna S. Diagnosi e terapia dello stroke ischemico pediatrico in fase acuta. Linea guida SIP-SIMEUP-SINP, 2007.
13. Rivkin MJ, deVeber G, Ichord RN, et al. Thrombolysis in pediatric stroke study. Stroke 2015;46(3):880-5. doi: 10.1161/ STROKEAHA.114.008210.
14. Wang M, Hays T, Balasa V, et al.; Pediatric Coagulation Consortium. Low-dose tissue plasminogen activator thrombolysis. J Pediatr Hematol Oncol 2003;25(5):379-86. doi: 10.1097/00043426-200305000-00006.
15. Harrar DB, Salussolia CL, Kapur K, et al. A stroke pediatric alert decreases to diagnosis of brain attack symptoms in a pediatric Emergency Department. J Pediatr 2020;216: 136-41.e6. doi: 10.1016/j.jpeds.2019.09.027.
Corrispondenza: alexander82@tiscali.it