After pediatric stroke, it’s time to enable!

Introduction: Although rare, pediatric stroke is more common than one may think. Deficits may not be evident in the short term but emerge months or years later, when psychomotor development, educational, and social requirements increase. Aims: To characterize the pediatric population with stroke followed at the Physical and Rehabilitation Medicine (PRM) consultation in a tertiary center and compare it with data in the literature and review the evidence on pediatric stroke rehabilitation care. Material and Methods: This was a retrospective study focusing on the first observation of stroke patients followed at a pediatric PRM consultation over 12 months. Gender, age, type of stroke, vascular territory, risk factors, functionality, event recurrence, and mortality were assessed. A bibliographic search was conducted on PubMed and Medline using the keywords ‘stroke’, ‘pediatric’, ‘perinatal’, ‘neuroplasticity’, ‘functionality’, and ‘rehabilitation’. Inclusion criteria comprised meta-analysis, systematic review, and review type of studies, written in Portuguese and English languages, and focusing human studies. Results: The study included 42 patients, 25 of whom were male (60%). Perinatal stroke was reported in 33 patients (13 in the prenatal period and 20 up to 28 days of life). Ischemic stroke was reported in 35 cases (83%), with the middle cerebral artery being the most affected vascular territory in 29 cases (69%). Fifty percent of patients had known risk factors, specifically prematurity in 21%. Fifty to 75% of patients had high functionality levels. No stroke recurrence or deaths were reported during the study period. Rehabilitation care should be implemented as soon as possible. Evidence-based guidance is still lacking for this population. Conclusions: Stroke, although uncommon in the pediatric population, is a major cause of morbidity and mortality. Diagnosis is challenging, as symptoms are often subtle and mimic other more frequent diseases in this age group. Timely referral to the physiatrist allows integration of the child into a rehabilitation program, optimizing neuroplasticity and improving participation in several activities.