Stroke in neonates and children is a rare but serious condition with an annual incidence of 1–13 per 100 000 at risk (Schoenberg et al. 1978; Broderick et al. 1993; Fullerton et al. 1979–98; Kothari et al. 1995). There are few acute management protocols in the literature, and even fewer randomised trials in the paediatric age group. This is in contrast with adult stroke where numerous trials have been undertaken, culminating in the FDA approval of tissue plasminogen activator (TPA) for ischaemic stroke up to 3 h from symptom onset.
Given the contribution of genetic and congenital factors, the causes of stroke in paediatric patients only partially overlap with those of adult stroke. Among children, one would anticipate that certain cerebral responses might be affected differently depending on, for example, whether the fontanelles were open or closed, in the latter case strokes perhaps more resembling the pathophysiological
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