The Ministry of Health has given us the following tasks :

Mission 1 : Networks, International 

• The center leads and coordinates the pediatric stroke networks at national level.
• The center participates in international work and events related to pediatric stroke.

Mission 2 : Protocols and recommendations

• The center develops and promotes care protocols and recommendations.

Mission 3 : Information gathering, data use

• The centre organises the collection of information on pediatric stroke and uses the data to advance knowledge.

Mission 4 : Information and training

• The center provides support for the development of information and training materials for health professionals.

Mission 5 : Research

• Development of an action plan for the reference center in terms of research (basic, translational, clinical).
• Animation and coordination of research.
• Coordination for the response to calls for projects, elaboration of protocols in consultation with the various associated centers, monitoring of research programmes.
• Initiatives in the animation of research: organisation of colloquia, conferences, etc.

Mission 6 : Referral

• Remote expertise: advice for complex cases at the request of regional teams in charge of pediatric stroke with the use of telemedicine, if necessary.
• Expertise in the center : organisation of a multidisciplinary consultation for cases admitted to the center due to their complexity.

What is a stroke?

The generic term » stroke » refers to a group of diseases that are diverse in terms of their pathophysiology, risk factors, clinical presentation and treatment.

It includes :

• Brain hemorrhages (or hemorrhagic strokes), caused by the rupture of an intracranial blood vessel. Vascular malformations are responsible for the majority of brain hemorrhages in children.
• Ischemic strokes, due to focal decrease in cerebral blood flow. If circulation is quickly restored, all of the clinical signs disappear and we speak of a transient ischemic attack (TIA). Conversely, if this phenomenon is prolonged, the brain tissue which no longer receives enough oxygen and glucose is destroyed. This is called an arterial or venous cerebral infarction depending on the nature of the vessel involved.
• Arterial occlusion results either from the migration of a clot (embolic stroke) or from primary parietal damage to arteries which are responsible for the blood supply to the brain (focal cerebral arteriopathy).
• Venous occlusion depends on the interweaving of local (often neighboring infection) and general (dehydration, thrombophilia, inflammation) factors. Due to the support network, it is not always accompanied by ischemia and may remain asymptomatic or manifest as headaches, intracranial hypertension or hemorrhage.

This general classification of stroke (arterial / venous; hemorrhagic / ischemic) logically applies to children. It is nevertheless necessary to consider in pediatrics, the particular place of infarctions of the perinatal period.. The main specificity at this age is the absence of compulsory concomitance between the occurrence of a brain lesion and clinical signs. Some accidents, which start during fetal life, may be symptomatic during the neonatal period, while others which occur at birth may go unnoticed for several months or years.

We then speak of perinatal cerebral infarction comprising three categories :

• Fetal cerebral infarction, diagnosed before birth by antenatal imaging or neuropathological studies in stillborn babies.
• Neonatal cerebral infarction, giving rise to neurological symptoms and diagnosed between birth and the 28th day of life.
• Suspected perinatal cerebral infarction, diagnosed in children over 28 days of age in whom the ischemic event is presumed to have occurred between the 20th week of fetal life and the 28th postnatal day. The hypothesis being that an accident occurring between the neonatal period and that of the diagnosis would have been symptomatic at the time of its constitution.

Moreover, the stroke is only the emergent part of the cerebrovascular disease. If the term stroke refers to the suddenness characteristic of the neurological deficit, cerebrovascular disease has more insidious consequences, indicating chronic ischemia or repeated micro-bleeding, sometimes without any stroke.

These lesions, visible on imaging, are well identified in the course of Moyamoya and sickle cell disease. Deceptively silent and long neglected, they can form a progressive neurocognitive picture, and are now the subject of therapeutic trials.

• ETP anticoagulation à domicile chez l’enfant

• Moyamoya disease and syndrome in children and adults (2016)
• Cerebral sinovenous thrombosis in children (2021)

• KID Clot study : evaluation of recanalisation treatments in children in the acute phase of cerebral artery infarction – Finalised – Currently in publication.
• PASTA study : a multicenter randomised interventional study of the efficacy of corticosteroids in children with cerebral infarction and unilateral focal cerebral arteriopathy – Ongoing.
• PICH Study : Imaging biomarkers of clinical prognosis after hemorrhagic stroke in children – Ongoing.

Cohorts : Neonatal stroke – 100 patients included

• IUD Theoretical and practical training in neurovascular pathology
  Paris university
• UD Neurovascular diagnostic and therapeutic imaging
  Paris university
• UD On-line teaching on sickle cell disease
  Paris university
• IUD of surgical resuscitation of congenital heart disease
  Paris-Saclay university
• IUD Pediatric neurology
  Aix-Marseille II, Angers, Claude Bernard-Lyon 1, François-Rabelais Tours, Lille 2 Droit et Santé, Montpellier I, Paris Descartes-Paris V, Paris Diderot-Paris 7, Paris-Sud 11, Paul Sabatier-Toulouse III, Picardie Jules Verne, Pierre et Marie Curie-Paris 6, Reims Champagne-Ardenne universities

• Association Tanguy Moya Moya
• France AVC Île de France

Pediatric stroke

Pediatric stroke and PM&R follow-up

Pediatric stroke & research

Every minute matters

Pediatric stroke & language #1

Pediatric stroke & language #2

Neuroimaging techniques

Role of the neuropsychologist

The neuropsychological assessment of the child

Role of the physiotherapist

These videoconferences for families and professionals, organised by the national reference center for pediatric stroke and the EnJeu[x]-Children & Youth programme, addressed issues related to the management of children’s disability within families, and particularly within siblings. The aim of this series of conferences was to take a multidisciplinary and transdisciplinary look at pediatric stroke, thanks to the intersection of approaches from the medical sciences, engineering sciences and also the human and social sciences.

News and rehabilitation
In addition to the subject of acute stroke management, there are currently many questions concerning the rehabilitation to be offered in order to promote as good a « recovery » as possible. This theme of rehabilitation was addressed by Pr Mickaël Dinomais, Dr Bertrand Schoentgen, Denis Jaquemot, Dr Roxane Varangue and Dr Marine Cacioppo.

Schooling and participation
Dr Mathilde Chevignard : Cognitive development after a stroke and impact on daily life and schooling, Dr Alain Pouhet : Pediatric stroke, a new stage: dealing with possible cognitive disorders. Virginie Baillargeau (Vyv 3), Virginie Hoche (Envoludia), Cécilia Pineau and Edith Cousin (UEROS prestation jeune) then took the floor during a « round table » tackling the themes of early childhood and the teenage/adult transition.

Siblings
Régine Scelles : The occurrence of a stroke, bringing siblings out of the shadows: trauma and resources, Christelle Lecellier (APF 53), Edith Mauboussin (Les Pachas), Bénédicte Jobert (L’envol) : In practice, what support systems are available for siblings?

The family
Aubeline Vinay : Disability in the family and attachment stories, Alix Bernard : Disability and self-representation within the family, Anne Boissel : Grandparents and disability.