Follow-up for Ischemic Cerebrovascular Disease in Children

Frequency of Office Visits

Follow-up schedules for children who suffered ischemic stroke are highly variable given the range of stroke etiologies and potential need for further diagnostic workup. The following are the authors’ general recommendations:

• Within 1 week of discharge: Follow up with pediatrician.
• Within 4 weeks of discharge: Follow-up with pediatric neurologist and/or specialized stroke clinic (256).
• If endovascular or surgical intervention performed: Schedule follow-up with the neurosurgery or neurointerventional radiology clinic within a few weeks of discharge.
• Other follow-up determined by stroke etiology: Follow-up with other specialists, including pediatric rheumatologists, immunologists, cardiologists, hematologists, and cardiac surgeons may be indicated, as determined by stroke etiology.
• Other follow-up determined by delays and deficits: For patients with developmental delay or persistent neurological deficits, follow-up with developmental and behavioral pediatrics and neuropsychology; physical, occupational, and speech therapy may be required.

Frequency of Imaging

• No explicit guidelines: There are no explicit guidelines regarding the frequency of follow-up imaging for pediatric ischemic stroke. This is likely due to the wide range of stroke etiologies, potential need for long-term surveillance of vascular pathology in certain cases, and the variable nature of persistent neurological deficits (which may or may not be present). Neurologists, neurosurgeons, and neurointerventional radiologists should work in close coordination with other specialists to determine whether further imaging is needed.

Other Investigations Required

• Potential need for further diagnostic workup: As has been described, there are numerous etiologies of pediatric ischemic stroke, and the underlying cause may not be known at the time of presentation. Patients may require further workup to elucidate the underlying cause of their stroke; this may involve laboratory testing, cardiac evaluation, biopsy, genetic screening, and other modalities. For many patients, thorough diagnostic workup can help optimize stroke prevention strategies and address other disease manifestations.