Arterial ischemic stroke (AIS) is a devastating condition, affecting 1.6-5/100,000
children/year. Although their outcome is different, children with stroke do not recover
better than adults, with at least 2/3 suffering long term sequels such as developmental
(motor, global intellectual, language...) and behavioral disabilities, epilepsy, and low
adaptative and academic skills...
Stenotic cerebral arteriopathy is identified as AIS etiology in 60-80% of previously healthy
children and the course of this arteriopathy is the strongest predictor of recurrent events.
30-40% of these children have a focal unilateral cerebral arteriopathy (FCA). Childhood FCA
is suspected to be an inflammatory vessel wall pathology triggered by varicella and other
(viral) infections. As recurrences occur for the great majority in the first 6 months after
the index event, aspirin 5 mg/kg/day is recommended for at least 18 months to 2 years.
As there is a rational for using immunomodulatory drugs at the acute stage of FCA,
immunotherapies are currently used by neuropaediatricians in AIS, mainly as steroids for
children with stenosing arteriopathies. However, due to weak evidences, the literature cannot
either encourage or discourage this practice.
The long term course of children with FCA is only approach to date by retrospective studies
and controversies about outcome remain (for example, the recurrence risk on antithrombotic
treatment varies notably from quasi zero to 25%). And finally, it is shown in childhood
stroke, as well as in the global field of longstanding impairment, that parental and medical
points of view do not match consistently. Longitudinal studies are needed to deserve this
familial approach.