Describe four cases of pediatric ischemic stroke who received intravenous tissue plasminogen activator (IV tPA).

Pediatric acute ischemic stroke is an uncommon cause of neurologic morbidity. Without acute management, pediatric patients may suffer from long term disability and decreased quality of life. Use of IV tPA is controversial. There is no standard management in children, in contrast to adults, in which the use of IV tPA is the standard treatment during the first 4.5 hours of AIS and has shown to improve overall outcomes significantly. Current pediatric stroke treatment is focused on supportive care and secondary prevention.

Case Series

Case 1:
7-year-old with acute ischemic stroke from vasculopathy, NIHSS 20, mRS 4 (nonverbal and wheelchair dependent) manifesting with right hemiparesis, given IV tPA. Patient was discharged home at premorbid function with no complications.

Case 2:
6-year-old with acute ischemic stroke in left MCA territory seen manifesting with right hemiparesis, global aphasia, NIHSS 22, mRS 0, given IV tPA. Exam improved throughout hospital course and she was discharged in stable condition to inpatient rehabilitation with no complications.

Case 3:
13-year-old with acute ischemic stroke with M1 occlusion, manifesting with right hemiparesis, expressive aphasia, NIHSS 14, mRS 0, given IV tPA, no thrombectomy due to clot migration. Examination improved with near return to baseline. She was discharged home with no complications.

Case 4:
16-year-old with acute ischemic stroke with right M1 occlusion, manifesting with left hemiparesis and sensory loss, right gaze preference, NIHSS 12, mRS 0, given IV tPA and underwent mechanical thrombectomy. Examination improved to only mild sensation loss at discharge. Repeat CT head with no hemorrhage. Discharged home with outpatient rehabilitation.

Our case series demonstrated no complications with IV tPA use and further studies and consideration should be given for treatment in the pediatric population.