Nontraumatic Stroke in Children

Ischemic stroke in children is a relatively rare entity compared with the adult population. The World Health Organization's MONICA Project defines stroke as "rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or longer or leading to death with no apparent cause other than of vascular origin." The definition includes ischemic and hemorrhagic infarction and intracerebral and subarachnoid hemorrhage. In adults, 80%-85% of strokes are ischemic, whereas the remaining 15%-20% are hemorrhagic. In children, 55% are believed to be ischemic, and the remainder hemorrhagic. In this chapter, the major causes of nontraumatic stroke in children are reviewed with an emphasis on diseases with neurosurgical relevance, particularly moyamoya syndrome. Reference will be made to the American Heart Association (AHA) Scientific Statement on the Management of Stroke in Infants and Children as a resource for current management guidelines.