Paediatric stroke. Who should be treated?

The past decade has seen a dramatic increase in pediatric stroke research. However few studies have addressed antithrombotic safety or effectiveness. Three paediatric stroke guidelines combining research data with expert consensus have been published in the past five years. For most patients treatment recommendations are consistent. Newborns with arterial ischaemic stroke (AIS) rarely require antithrombotic treatment given their extremely low risk of recurrence. In children with AIS a substantial recurrence risk means that antithrombotic treatment is required unless contraindicated. Anticoagulation (heparins, warfarin) is recommended for possible or established dissection and cardiogenic embolism. Antiplatelet treatment is recommended for other children with AIS. For neonatal cerebral sinovenous thrombosis (CSVT) most centers provide initial anticoagulation in the absence of haemorrhagic contra indications, and otherwise, monitor for propagation. Children with CSVT, even with haemorrhagic infarction, more consistently receive anticoagulation, as in adults. While more studies are necessary, current treatment guidelines offer an interim option for guiding the treatment of paediatric stroke.