In children however 55% strokes are ischemic while the rest are hemorrhagic. Stroke in children is considered a very different entity than stroke in adults. An important contributor to this difference is the vast array of predisposing risk factors in paediatric population that leads to stroke compared to atherosclerosis being the single most important risk factor in adults. The rarity of this event in paediatric population and the multiple risk factors which are involved makes it very difficult to conduct research on stroke in children. Hence it is a very difficult diagnosis to establish (E. S. Roach). When symptoms lack for less than 24 hours it is called a transient ischemic attack. There are three types of recognised stroke syndromes in children 1. Arterial ischemic stroke: caused by ischemia due to blockage of an artery because of a clot or stenosis. 2. Cerebral Sinovenous thrombosis: Brain injury because of clotting of blood in the venous system. This may lead to an ischemic stroke or haemorrhage or get better on its own because of the anti thrombotic mechanisms of the body. 3. Intracranial haemorrhage. Injury to a brain vessel leading to haemorrhage in the brain tissue. Initial symptoms can include weakness in hands or face towards one side of the body, sudden headache, vomiting, slurred speech and problems with vision on one or both eyes. Initial management: The initial management of stroke in children is remarkably different from that in adults. In children because of the various risk factors, varied presentation and not enough research it is necessary to evaluate the child thoroughly. The most important step in management is neuroimaging. It is necessary to establish that the patient has had a cerebrovascular event. Neuroimaging gives us a direct approach and is the best way to ascertain the diagnosis. Once it is established that the patient has had a cerebrovascular event and the extent of damage is known it is important to identify the risk factors for stroke. Stroke in children is varied in its aetiology and a general set of criteria for management is not agreed upon. This leads to the practice of treating every patient individually, but treatment is guided by the type of stroke that the patient has had to some extent. Generally every patient must have a complete blood work to rule out clotting disease, should be checked for congenital heart disease because of increased likelihood of stroke recurrence and should be evaluated for sickle cell disease as strokes are very common in patients with sickle cell disease. Since all the different types have different treatment and symptoms each one is given in detail below. 1. Arterial ischemic stroke. Arterial ischemic stroke can occur because of several reasons including but not limited to thrombosis, embolism, and stenosis, clotting disease and damaged arteries because of trauma or inflammation. Symptoms occur suddenly most of the time and include weakness of the face and arms towards one side, slurred speech, lack of understanding, loss of balance and severe headache with nausea and vomiting. New incidence of seizures followed by paralysis to one side of the body can be an important symptom. It is hard to find out the exact cause for AIS in children still one has to look for risk factors. The most common ones being congenital heart defects, sickle cell anemia, neck radiation, moyamoya disease, serious infections like meningitis, drug abuse and chronic metabolic disorders. Diagnosis is achieved
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