Thrombolysis in a Child with Acute Arterial Ischemic Stroke without Large Vessel Occlusion
Bibliographic record
Abstract
A 14-year-old male experienced thunderclap headache, dysarthria, and expressive aphasia followed by complete loss of vision and consciousness.He arrived to hospital 25 min after onset.Initial assessment found no verbal response, bilateral withdrawal to painful stimuli, and rightward gaze.A non-contrast computed tomography scan performed 40 min after arrival was normal.PedNIHSS was 23 given decreased level of consciousness, inability to answer questions or follow commands, sustained rightward gaze, and no effort in movement against gravity (Table 1).Magnetic resonance imaging (MRI) obtained 70 min after arrival revealed areas of diffusion restriction within the right cerebellar hemisphere, the posterior aspect of the cerebellar vermis and both thalami.Time-of-flight MR angiogram (MRA) showed patency of all major cerebral arteries (Figure 1).The patient was treated with intravenous tissue plasminogen activator (IV tPA) despite patency of all large vessels.Treatment was started 3 h 20 min after arrival to hospital.The patient received IV tPA 0.9 mg/kg total, with 10% of the total dose given over the first 5 min and the remainder infused over 1 h.He regained consciousness.PedNIHSS following thrombolysis was 5 given bilateral limb ataxia, moderate aphasia, and severe dysarthria (Table 1).No deficits were discernible on exam 48 h later.Repeat MRI showed expected evolution of the areas of ischemia and no interval bleeding (Figure 1).The patient was started on unfractionated heparin and transitioned to enoxaparin.He was discharged home 6 d later, immediately returning to all activities of daily living.Investigations performed for coagulopathy, rheumatological, infectious or metabolic causes of stroke, electrocardiogram, echocardiogram, and bilateral leg ultrasound for deep vein thrombosis were unremarkable except for transthoracic echocardiogram revealing a small patent foramen ovale shunting left to right.Stroke is a rare neurological disease in children.While prognosis is generally superior to that following adult stroke, morbidity following pediatric arterial ischemic stroke (AIS) is substantial.1 Diagnosis of pediatric stroke is challenging and options for acute intervention are limited.Therapies that have revolutionized adult stroke remain undefined in children.Many retrospective reviews have evaluated the rate of use of thrombolysis in pediatric AIS.One particular study suggested a rate of 3% thrombolysis in pediatric AIS. 2 This study also highlighted the shortcomings of evidence for thrombolysis in pediatric stroke including frequent administration outside recommended time intervals, substantial rate of poor outcomes, including death or neurological deficit, and risk of associated intracranial hemorrhage. 2 A larger retrospective study found a similar rate of thrombolysis in pediatric AIS. 3 The overall
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.006 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.007 | 0.005 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".