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Question: Stroke

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You are seeing a 3 year old child with unrepaired Tetralogy of Fallot who presented with a generalized tonic-clonic seizure, and residual hemiparesis and speech difficulty after waking up from the post-ictal phase. 

Which of the following is true of pediatric stroke?
9 votes

pemsou5_wp • February 23, 2021

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  1. Kelly February 23, 2021 - 9:15 pm Reply

    D) Recombinant tissue-type plasminogen activator (tPA) is rarely given in pediatric stroke because diagnosis is often made too late
    Seizures, face/arm/leg weakness, and speech difficulties are common signs of pediatric stroke. MRI/MRA is the preferred imaging if available. Patients’ head of bed should be kept flat to maximize cerebral perfusion pressure (unless elevated ICP is a concern). Although it is important to normalize hypoxemia, hypoglycemia, and hyperthermia to maximize good neurologic outcome, mild permissive hypertension (up to 20% above 95th percentile) is allowable for the sake of cerebral perfusion. tPA is considered if within 4.5 hours of onset of stroke symptoms, but the median time to diagnosis is 24 hours due both to delays in presentation and in diagnosis.

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