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July 2016

Back to Basics—Vital Sign and Blood Glucose Abnormalities and Outcome in Childhood Arterial Ischemic Stroke

Author Affiliations
  • 1Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut
  • 2Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut
JAMA Neurol. 2016;73(7):785-786. doi:10.1001/jamaneurol.2016.1054

Childhood stroke studies often cite differences in risk factors between adult and pediatric patients, namely that traditional adult stroke risk factors, such as hypertension and hyperglycemia, are not common causes of childhood stroke.1-4 In a study2 of 83 children from the United Kingdom, only 8 children (10%) with available blood pressure data at admission were classified as having hypertension. The authors stated that this could be an overestimate because follow-up blood pressure data were not available, but they acknowledged that elevated blood pressure could be important in some children.2 In a multinational cohort4 of 676 children with arterial ischemic stroke, only 12 children (1.8%) were considered to have traditional adult stroke risk factors, which included 9 children with hypertension and 1 with type 1 diabetes. In another report5 of 63 children with arterial ischemic stroke, nearly one-third had blood pressure measurements that were considered mildly or moderately elevated at presentation. Although the American Heart Association Scientific Statement regarding the management of stroke in children states that supportive measures for arterial ischemic stroke should include “control of fever, maintenance of normal oxygenation, control of systemic hypertension, and normalization of serum glucose levels,”6 these recommendations are based on consensus expert opinion (Class I, Level of Evidence C). Furthermore, no guidance is provided about what values should be considered abnormal in this setting or what agents should be used to make corrections.

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