SYNOPSIS
Although considered uncommon by adult standards, stroke is more common than brain tumours and it is amongst the top ten causes of death in children. Contrary to traditional views, it is now accepted that children don’t necessarily recover better than adults, with over half of survivors having long-term neurological and cognitive impairments.
The licensing of acute thrombolytic agents has transformed adult stroke care from prevention and rehabilitation to the implementation of emergency treatments to restore blood flow, thereby minimising extent of brain injury. However access to such treatments is time limited with improved outcomes only proven up to 6 hours following stroke. Four recent paediatric studies have shown the average time delay to paediatric stroke diagnosis is more than 24 hours. Children will not receive the same benefits as adults without strategies to improve timely diagnosis of stroke.
Rapid clinical recognition of stroke is the first step to improving access to time critical treatments but differentiation of stroke from less serious conditions is often challenging for the non neurologist. The presentation will focus on the most common patient presentations (i) children presenting to the ED with focal “brain attack” symptoms or altered consciousness, (ii) newborns with seizures or apnoea on post natal wards and (iii) children with congenital heart disease. Clues to the clinical diagnosis of stroke and common conditions mimicking stroke will be discussed. Data will be presented on research currently being conducted at RCH and MCRI to better understand reasons for delayed diagnosis and the development clinical stroke recognition tools to improve accuracy of stroke diagnosis in children. Priorities for future research to improve care of children with neurological emergencies will be discussed.
SPEAKER
Dr. Mark Mackay is a Paediatric Neurologist, and founder of the Paediatric Stroke Program at the Royal Children’s Hospital. He has honorary research appointments at MCRI and the Florey Institute of Neuroscience and Mental Health. Dr Mackay has over a decade of experience in paediatric stroke and epilepsy research projects and has many publications in these fields. Dr Mackay is nearing completion of his PhD focusing on strategies to improve recognition, assessment and acute management of childhood stroke. Specifically his PhD aims to (i) explore reasons for delayed recognition of stroke amongst parents and paramedics, (ii) develop a bedside recognition tool to assist paramedics and paediatric emergency physicians to differentiate stroke from other neurological disorders and (iii) explore the use of neuroimaging techniques to identify salvageable brain in acute stroke. Dr Mackay is a member of the Australian Stroke Clinical Registry steering committee and an executive committee member of the International Pediatric Stroke Study group. He serves in an advisory capacity for Strokidz, an Australian parent support group for children affected by stroke