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MODERN CONCEPTS OF DIAGNOSIS AND TREATMENT OF CHILDREN'S
ISCHEMIC INSULT
Jumayeva Mahliyo Jahongirovna
Bukhara State Medical Institute named after Abu Ali ibn Sino. Bukhara, Uzbekistan.
e-mail:
Annotation:
This article includes a review of the results of characteristic CT and MRI
studies associated with the monogenetic causes of ischemic and hemorrhagic stroke in
children and adolescents. Stroke is a relatively rare, but significant cause of short-term and
long-term morbidity and mortality in children. We studied it in three categories: arterial
ischemic stroke (AIS), hemorrhagic stroke (HI), and cerebral synovial thrombosis (CST).
The etiology of AIS in children is diverse and differs from the etiology of adult stroke, the
main ones being congenital heart diseases, vasculopathies, hematological disorders, and
prothrombotic conditions. Additional factors may be related to age group, ethnic and
geographical factors. Early detection allows for the start of rapid therapy and thereby
reduces the risk of further recurrence and complications. Comparative analysis of symptoms
in arterial ischemic stroke (AIS) and stroke-like conditions in children, the presumed stroke
scale in children for prehospital diagnosis of AII in children and their analysis.
Keywords:
stroke, pediatric stroke, arterial ischemic stroke, stroke masks, pre-hospital
diagnosis of stroke, early diagnosis of stroke.
Аннотация:
В данной статье представлен обзор результатов характерных КТ и МРТ,
связанных с моногенетическими причинами ишемического и геморрагического
инсульта у детей и подростков. Инсульт является относительно редкой, но
значительной причиной краткосрочной и долгосрочной заболеваемости и смертности
у детей. Мы разделили его на три категории: артериальный ишемический инсульт
(АИИ), геморрагический инсульт (ГИ) и церебральный синовозный тромбоз (ЦСТ).
Этиология ДИА у детей разнообразна и отличается от этиологии инсульта у взрослых,
основными из которых являются врожденные заболевания сердца, васкулопатии,
гематологические нарушения и протромботические состояния. Дополнительные
факторы могут быть связаны с возрастной группой, этническими и географическими
факторами. Раннее выявление позволяет начать быструю терапию и тем самым
снизить риск последующих рецидивов и осложнений. Сравнительный анализ
симптомов при артериально-ишемическом инсульте (АИИ) и инсультоподобных
состояниях у детей, шкала предполагаемого инсульта у детей для догоспитальной
диагностики АИИ у детей и их анализ.
Ключевые слова:
инсульт, детский инсульт, артериальный ишемический инсульт,
маски для инсульта, догоспитальная диагностика инсульта, ранняя диагностика
инсульта.
Аннотация:
Ушбу мақола болалар ва ўсмирларда ишемик ва геморрагик инсультнинг
моногенетик сабаблари билан боғлиқ характерли КТ ва МРТ натижаларини кўриб
чиқишни ўз ичига олган. Инсульт болаларда қисқа ва узоқ муддатли касалланиш ва
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ўлимнинг нисбатан кам учрайдиган, аммо анча аҳамиятли сабабидир. Уни уч тоифага
артериал ишемик инсульт (АИИ), геморрагик инсульт (ГИ) ва серебрал синовоз
тромбоз (ССТ) бўлиб ўргандик. Болалар АИСнинг этиологияси турлича ва катталар
инсультининг этиологиясидан фарқ қилади, уларнинг асосийлари туғма юрак
касалликлари, васкулопатиялар, гематологик бузилишлар ва протромботик
ҳолатлардир. Қўшимча омиллар ёш гуруҳи, этник ва географик омиллар билан боғлиқ
бўлиши мумкин. Эрта аниқлаш тезкор терапияни бошлашга имкон беради ва шу
билан кейинги қайталаниш ва асоратлар хавфини камайтиради. Болаларда артериал
ишемик инсульт (АИИ) ва инсультга ўхшаш ҳолатларда симптомларнинг қиёсий
таҳлили, болаларда АИИни шифохонагача ташхислаш учун болаларда тахмин
қилинган инсульт шкаласи ва уларнинг таҳлили.
Калит сўзлар:
инсульт, болалар инсульти, артериал ишемик инсульт, инсульт
ниқоблари,
инсультнинг
шифохонагача
диагностикаси,
инсультнинг
эрта
диагностикаси.
Stroke is defined as focal brain damage and neurological deficits resulting from sudden
blockage or rupture of cerebral arteries or veins. Types of stroke caused by vascular
occlusion include arterial ischemic stroke (AIS) and cerebral sinovenous thrombosis (CSVT),
while stroke resulting from vascular rupture is called hemorrhagic stroke. Stroke in children
is relatively uncommon and often leads to lack of recognition and delayed diagnosis. The
etiology of stroke in children is multifactorial, and unlike the single-factor etiology in adults,
several risk factors typically coexist in pediatric cases. Vasospastic conditions such as
congenital or acquired heart disease, malformations, metabolic and hematological disorders,
and migraines are more common in childhood strokes. The purpose of the diagnostic
assessment is to confirm the presence of cerebrovascular damage, exclude other types of
neurological dysfunction, and determine the etiology of the stroke. Treatment of stroke in
children is primarily aimed at stabilizing systemic factors and eliminating the main causes.
Various antithrombotic and non-antithrombotic therapies are discussed. The use of
anticoagulant therapy in AIS in children is increasing. Mortality after a stroke in children is
20-30% depending on the localization and underlying cause. More than 50% of survivors
have residual neurological dysfunction.
Childhood stroke has several etiologies, which differ mainly from those of adults. Genetic
discoveries in the last decade have shown that monogenic diseases, including ischemic
stroke of small vessels and arteries, are a rare but significant cause of ischemic stroke in
children and young people. These discoveries helped to understand that stroke in children
can be a sign of a major genetic disorder. Identification of these diseases requires a detailed
medical and family history, a thorough clinical assessment and neuroimaging assessment to
identify systemic symptoms and signs. Correct etiological diagnosis and understanding of
genetic risk factors for stroke are important steps for identifying the underlying mechanisms,
optimizing the development of specific prevention strategies, and in some cases, identifying
new therapeutic goals.
1. Arterial ischemic stroke (AIS)
Arterial ischemic stroke occurs when blood supply in one of the cerebral vessels is
disrupted, often due to thrombus formation or embolism. This leads to insufficient intake of
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oxygen and nutrients into brain tissue, which can cause their injury or death. Three types of
AIJ are distinguished:
Thromboembolic stroke - an embolism caused by the formation of a thrombus in the
vessels of the brain or obstruction of the vessels of the brain by a thrombus or a piece of
tissue of another organ (often from the heart).
Cardiogenic stroke - occurs due to embolism, often caused by heart diseases such as
atrial fibrillation or heart defects.
Stenosing stroke develops due to arterial stenosis, which limits blood flow to the
brain, especially in the carotid artery area.
2. Hemorrhagic stroke (HS)
Hemorrhagic stroke occurs as a result of hemorrhage into brain tissue due to rupture of a
blood vessel in the brain. Hemorrhagic stroke is divided into two types:
• Intracerebral hemorrhage (IH) is the most common type, with hemorrhage occurring
directly in brain tissue, often due to hypertension, aneurysm, or atherosclerosis.
• Subarachnoid hemorrhage (SAH) - the entry of blood into the space between the meninges
(subarachnoid space), often caused by rupture of a brain aneurysm.
3. Cerebral synovial thrombosis
Cerebral synovial thrombosis is a rare disease in which a thrombus forms in the cerebral
veins, disrupting the normal flow of venous blood. This leads to venous congestion, brain
edema, and neuronal damage. This type of stroke can be caused by various factors, such as
infections, injuries, blood clotting disorders, or pregnancy.
Despite the increasing recognition of monogenic causes of stroke, genetic diseases in
children with stroke have not been sufficiently studied and are therefore rarely detected. For
timely and accurate diagnosis, it is very important to increase the knowledge of medical
workers in this area. In this review, we provide a brief overview of the main monogenous
diseases that can manifest as ischemic stroke in childhood and describe their clinical signs.
Based on the subtype and descriptive features of stroke, which may indicate a monogenic
diagnosis of ischemic stroke in children, we present a set of practical recommendations for
identifying these rare causes of stroke. The current difficulties in genetic analysis of children
with ischemic stroke and future prospects will also be discussed.
Congenital heart disease, vasculopathies, hematological disorders, and prothrombotic
conditions are a group of diseases that can have a significant impact on children's health.
These disorders can manifest at an early age and require a comprehensive approach to
diagnosis and treatment. To improve the quality of life of children and provide timely
intervention, it is important to understand these diseases, methods of their diagnosis and
treatment.
Congenital heart disease (CHD) is an anomaly that occurs as a result of improper formation
of the heart and blood vessels during the fetal period. VZS can range from mild disorders to
severe defects requiring surgical intervention. The most common types of VAT include:
1. Anomalies of the heart septum (defects of the interatrial and interventricular septum).
These are the most common defects, which are often diagnosed in children in the first years
of life.
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2. Stenoses and insufficiency of the heart valves. These conditions can lead to blood flow
difficulties and heart strain.
3. Tetralogy of Fallot - a complex defect involving several anomalies, such as pulmonary
artery stenosis, ventricular septal defect, etc.
Vasculopathies are vascular diseases that can affect their structure and function. The
following diseases occur in children:
1.
Minor vasculopathies (e.g., Kawasaki disease) are inflammation of the vessels,
which can lead to aneurysms and other complications. This condition often occurs in young
children and requires immediate treatment.
2.
Childhood atherosclerosis - although atherosclerosis is usually age-related, in some
cases children may have symptoms of vascular diseases associated with heredity or other
factors.
3.
Hematological disorders in children can be diverse, including:
Anemia - a decrease in hemoglobin levels in the blood, which can lead to fatigue, weakness,
and growth retardation. Anemia can be caused by a deficiency of iron, folate, vitamin B12,
or other factors.
1.
Thrombocytopathy and thrombocytopenia are disorders of platelet count or function
that can lead to increased bleeding or, conversely, to thrombus formation.
2.
Haemophilia and other hereditary coagulopathies are disorders of blood clotting that
can cause prolonged bleeding after injuries or surgeries.
Prothrombotic conditions are diseases with a high risk of thrombus formation. In children,
these conditions may be associated with:
1. Hereditary disorders of the blood coagulation system. For example, antithrombin III or
protein C, Leiden factor B deficiency.
2. Adaptive states - for example, inflammatory diseases, infectious diseases, or prolonged
immobilization.
3. Genetic disorders that may increase the tendency to thrombus formation, such as
antiphospholipid antidiv syndrome.
Congenital heart diseases, vasculopathies, hematological disorders, and prothrombotic
conditions require timely diagnosis and treatment. Caring for children with these diseases
requires the joint efforts of a pediatrician, cardiologist, hematologist, and other specialists.
The earlier the diagnosis and treatment is initiated, the higher the chances of improving the
child's health and preventing serious complications.
Childhood stroke has several etiologies, which differ mainly from those of adults. Genetic
discoveries in the last decade have shown that monogenic diseases, including ischemic
stroke of small vessels and arteries, are a rare but significant cause of ischemic stroke in
children and young people. These discoveries helped to understand that stroke in children
can be a sign of a major genetic disorder. Identification of these diseases requires a detailed
medical and family history, a thorough clinical assessment and neuroimaging assessment to
identify systemic symptoms and signs. Correct etiological diagnosis and understanding of
genetic risk factors for stroke are important steps for identifying the underlying mechanisms,
optimizing the development of specific prevention strategies, and in some cases, identifying
new therapeutic goals. Despite the increasing recognition of monogenic causes of stroke,
genetic disorders in children with stroke have been little studied and therefore little
recognized. For timely and accurate diagnosis, it is important to raise the awareness of
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medical workers. In this review, we provide a brief overview of the main monogenous
diseases that can manifest as ischemic stroke in childhood and describe their clinical
manifestations. Based on the subtype and descriptive features of stroke, which may indicate
a monogenic diagnosis of ischemic stroke in children, we present a set of practical
recommendations for the diagnosis of these rare causes of stroke. Existing barriers and
future prospects in the genetic analysis of children with ischemic stroke are discussed.
Stroke is a rare occurrence in children, with rates ranging from two to eight per 100,000
children under 14 years of age, and in most cases, the underlying disease manifests as heart
disease, prothrombotic conditions, sickle cell disease, and vascular malformations. Currently,
there are no clear indications for the treatment of stroke in children, although the central
elements include supportive treatment, monitoring, and in some cases, anticoagulation as
secondary prevention. The prognosis depends on the degree of brain damage and the
underlying disease, but in most cases, the frequency of recurrence is high.
RESULT
Early diagnosis of stroke in children is very important, and pediatricians should be aware of
the non-specificity of symptoms to prevent late outcomes and improve quality of life.
Ischemic and hemorrhagic stroke remains a common cause of acquired disability in children
and adolescents, but is not sufficiently recognized. Cerebral parenchymal and vascular
tomography is usually performed as part of a comprehensive assessment of young patients
with stroke. Familiarization with these patterns of the disease allows for early detection of
the underlying hereditary disease. The results of the study allow us to speak about the
predominance of motor and coordination disorders and general cerebral symptoms in AII in
stroke-like conditions in children. The most common "stroke mask" is migraine. Based on
the research results, a Scale was proposed, and a preliminary assessment of the effectiveness
of the Scale was carried out using the example of confirmed cases of AII and "stroke masks".
Timely hospitalization of children with AII can not only reduce mortality, but also allow for
the use of modern diagnostic and treatment methods to reduce the volume of brain damage,
and allow for the full restoration of motor and cognitive functions. It is necessary to conduct
a deeper analysis of the sensitivity and specificity of the proposed scale.
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