Arterial Ischemic Stroke | Diagnosis & Treatment

How is an arterial ischemic stroke diagnosed?

Evaluation of an arterial ischemic stroke usually begins in the emergency room. A team of specialists will conduct a rapid physical examination and will work to quickly confirm and locate the cause of the stroke through imaging tests. These can include:

All of these tests are painless and noninvasive, although some might require placement of an intravenous (IV) line to deliver agents needed for certain types of imaging. Since MRI requires a child to hold still inside a scanner, very young children may need sedation.

In addition to imaging, the care team may collect blood samples to look for a medical condition that may increase risk for blood clotting.

How is arterial ischemic stroke treated?

An arterial ischemic stroke is a medical emergency, and treatment usually starts in the emergency department. There, the care team will quickly determine whether clot-dissolving drugs such as tissue plasminogen activator (tPA) should be administered or thrombectomy performed.

In cases when drugs alone cannot successfully restore blood flow and the child faces potentially severe neurologic problems, physicians may use tiny, catheter-based devices to remove the clot mechanically. Guided by neuroimaging, these devices are specially designed to extract or suction out the clot from the inside.

Based on the results of blood testing, your child may require additional treatment for a clotting disorder or blood disease. For example, if the stroke was caused by arterial dissection (a tear along the lining of an artery), the team may begin anticoagulation therapy to prevent further thrombus formation at the site of the arterial dissection. Rarely, placement of a stent inside the vessel or performance of bypass surgery to reroute blood flow around the dissection may be advised. If the stroke was caused by moyamoya disease, which leads to thickened, narrowed vessels, an operation called pial synangiosis can decrease the risk of future strokes by providing a new blood supply to the oxygen-starved parts of the brain.

Stroke specialists will oversee your child's long-term care and provide referrals to physical or occupational therapists and speech/language therapists to improve functioning and quality of life.