Читать книгу Pediatric stroke. Revascularization and reconstructive surgery in children with cerebrovascular disease - E. V. Shevchenko - Страница 10

A nation-wide Russian recommended list of diagnostic procedures aimed at differential diagnostics of a CVD at an early age does not exist. It is actively discussed and formed in some individual centers. The variability of the CVD causes considerably hinders the diagnostic search. During the most acute and acute disease periods, the efforts are focused on identifying the pathogenic variant of the CVD, primarily, on identification of the most frequent diseases, whose therapy can be started immediately (cardiac pathology, congenital clotting disorders, congenital and acquired pathology of cerebral vessels) with due regard for the age [22; 34]. If the cause has not been determined, it is recommended afterwards to rule out consecutively other, less common, causes of the CVD at an early age [7; 9; 22; 24; 134].

It is known that, despite a rather well-defined organization of the diagnostic process in foreign clinics, about 20% of ischemic strokes remain etiologically unexplained. The similar national indicator reaches 65 – 70% [161; 174; 280]. Despite the high cost of a laboratory-based instrumental examination and its long duration, such an examination must be held. The earliest clarification of the cause of an ACVD in a child is considered a high-priority and the most important mission of a diagnostic search at any phase of the disease. The accurate clarification of the etiology of an ischemic ACVD determines the focus of the corrective drug therapy, the system of preventive measures and the prognosis regarding the further course and recurrence of the disease.

Based on the FSBEI of Higher Professional Education «Urals State Medical University», a list of diagnostic activities, which are due to be held for examination of children with IS and TIA at an emergency (inpatient) stage, was developed and implemented into a routine practice (Table 3).

It must be noted that a consecutive clinical, laboratory-based and instrumental examination with the fulfillment of all items proposed above should be held even in the cases, when the cause of a stroke or TIA seems evident. This is due to the fact that, beside an evident cause, the presence of other, equally important, risks may be possible, which could lead to a pathology of the blood coagulation system. It is just these individual risk combinations, which, under the effect of the initiating agents, facilitate the realization of genetically determined prothrombotic readiness and lead to the formation of a focal spot of an infarction or TIA in children.

All stated above is aimed at the clarification of the ACVD causes as well as at the further prevention of recurring strokes. However, regarding the determination of indications for surgical treatment held, when the conservative therapy is not effective, or in addition to it, as well as when a surgical intervention method is selected, some additional tests are required to assess the state of major vessels and the cerebral circulation system. As distinct from adults, the algorithm of instrumental examination of children with cerebrovascular diseases is not developed yet.