Initially, edema is cytotoxic, although a vasogenic component occurs after two to three days. Edema is usually effectively managed with hyperventilation and fluid restriction. In general, the use of steroids and osmotic agents are not indicated. However in case of progressive deterioration, mannitol and decadron may be used. The use of anticoagulation in pediatric ischemic stroke is controversial, although it is often used in the presence of a definable and recurrent source of emboli or evolving thrombotic stroke.
Anticoagulation is contraindicated in hemorrhagic infarct and uncontrolled hypertension.
Low-dose aspirin is a consideration though controlled studies in children have not been performed. In patients with sickle cell disease, strokes should be initially treated with an exchange transfusion and then a hypertransfusion protocol. Rehabilitation through aggressive physical, occupational, and speech therapy is essential for all patients. Behavioral problems and learning disabilities may become apparent upon returning to school, and children may need neurocognitive testing and special educational classes. The prognosis for childhood strokes is variable and most dependent upon underlying etiology.