Thrombolysis in Stroke: Thrombolysis in Pediatric vs Adult Ischemic Stroke - Closing Clinical Knowledge GapsAndrea Eberly, MD, MS, FAAEM examines the differences between thrombolysis in pediatric vs. adult ischemic stroke.
In 2019, the American Heart Association (AHA) published updated adult and pediatric ischemic stroke guidelines. In what important ways are pediatric eligibility criteria for thrombolysis similar to/different from those for adults?
Try this case and test your knowledge of thrombolysis in pediatric versus adult ischemic stroke.
A 7-year-old girl with a history of sickle cell disease presents to the emergency department (ED) with her parents after a multi-hour drive to the next large hospital from their rural home.
The parents state that about 4 hours ago, their daughter was suddenly drooling and not responding normally while the family was watching TV.
She was also unable to move the left side of her body.
The parents also state that the patient has had a febrile illness with nausea, vomiting, and diarrhea for the last 3 days.
Her vital signs are:
- heart rate 105 beats/minute
- blood pressure 95/70 mm Hg
- respiratory rate 18 breaths/minute
- temperature 100.5 °F (38.1 °C)
- 98% pulse oximetry on room air
Examination reveals a somnolent, thin child who appears dehydrated.
Her neurological exam is consistent with a possible right-sided stroke in the distribution of a major cerebral artery.
During the exam, she has a brief, self-limited seizure.
Under what circumstances would this patient be eligible for thrombolysis with alteplase (TPA) if her workup is negative for a stroke mimic?
See the Answer:
Dr. Andrea Eberly is one of the seasoned medical experts that contribute to Med-Challenger Medical Education products for medical board certification exam preparation, maintenance of medical certification, and continuing medical education requirements.
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