Successful use of rt-PA in pediatric stroke

There are no widely accepted guidelines for the use of recombinant tissue plasminogen activator (rt-PA) in children with acute stroke. We report a single case of rt-PA use in a 13-year-old girl with acute hemiplegia. She had a history of previous stroke, secondary to carotid dissection, and additional stroke risk factors. Treatment with IV rt-PA resulted in rapid clinical improvement. Our experience suggests that in selected pediatric patients with acute ischemic stroke rt-PA can be safely administered, and that this treatment option should be considered in children. A 13-year-old right-handed girl had a history of ischemic stroke secondary to internal carotid artery dissection. She presented with subacute onset of headache and sensory deficit in her left hand. On noncontrast head CT, an area of poor gray/white differentiation in the right parietal region and possible clot in the right middle cerebral artery (MCA) was seen. Angiography showed right internal carotid dissection; there was no evidence of fibromuscular dysplasia or other vascular irregularity. Several days earlier, while swimming, the patient had bumped her head on the pool bottom; she had also carried several friends on …