Shaare Zedek Initiates New National Protocol to Reduce Cerebrovascular Accident (Stroke) Damages in Children



The first convention in Israel discussing strokes in children took place at Shaare Zedek Medical Center.

Strokes have very clear symptoms that are usually easy to identify. When an adult gets a stroke, diagnosis and treatment are fast and effective in preventing neurological damage. In children and adolescents, strokes are much rarer and the symptoms are not so clear. They can be caused by other illnesses and so parents and medical staff often do not diagnose the problem quickly or in time.

The first ever convention on this topic took place this year at Shaare Zedek, initiated by Prof. Shoshana Ravel-Wilk and Dr. Chagit Miskin (Pediatric Hematology), Dr. Ya'akov Amsalem (Invasive Neuroradiology) and Dr. Odiya Bennett (Pediatric Neurology).

The aim of the convention was to raise awareness to the topic among medical teams from different disciplines, to assess ways and tools for speedy diagnosis and treatment of strokes in children, because "time is brain" with them too and immediate treatment can limit complications and even save lives.

The convention showcased a proposal for a national protocol for fast identification and treatment of strokes in children, which presents the unique characteristics of the problem in newborns and in children, and the immediate types of treatment necessary to save lives and prevent permanent neurological damage. Upon completion, the protocol will be distributed to the ERs in all hospitals, community clinics and to pediatricians and family doctors around the country. 

"In cases of cerebral infarction, different age groups during childhood display different manifestations. The life of a baby or a child can radically change depending on the speed of their reactions. We are responsible for the next 80 years and so it is important to come in for an examination as soon as possible and treatment if necessary. This national protocol proposal we presented at the convention is a first step in raising awareness about the topic among pediatricians. We are now working on creating a committee, comprised of some of the top specialists in the relevant disciplines from all over the country, which will draft a national protocol agreed upon by all, and inspired by leading hospitals overseas," said Dr. Miskin, Director of the Pediatric Hematology and Oncology Unit at Shaare Zedek.

"The frequency and consequences of cerebral infarction in babies and children are higher than that of brain tumors in this population and so it is crucial to raise awareness among treatment providers and the wider public. In countries where there are protocols for diagnosing and treating cerebral infarction in infants and children they have seen significant improvement in the speed of diagnosis and treatment. Therefore, it is vital that doctors become familiar with the treatment protocol, which will act as a turning point in the treatment of these children," added Prof. Ravel-Wilk.

Lectures were presented by renowned figures from Israel and overseas, including Prof. Anthony Chan from Canada and Prof. Carlo Gandolfo from Italy, who detailed their experiences and added current knowledge of the topic, risk factors and drug-based and catheter-based treatment of the brain's blood vessels, with the aim of opening the clot and preventing repeated cerebral infarction.

Dr. Odiya Bennett, Pediatric Neurologist at Shaare Zedek, spoke about the clinical manifestations of strokes in children and the difficulties in characterizing them; Dr. Eliel Ben David, Brain Radiologist at Shaare Zedek, detailed the imaging media that allows for speedy diagnosis; Prof. Gilly Kenet, Director of the Hemophilia Institute and Pediatric Coagulation Service at Sheba Hospital, presented the topic of cerebral infarction in the fetus and in newborns; Dr. Gustavo Raiz, Pediatric Neurologist from Shaare Zedek, explained stroke cases in which neurosurgery is necessary; Prof. Michael Weintraub, from the Alyn Rehabilitation Institution in Jerusalem, expanded on the topic of rehabilitating children following a stroke and the importance of monitoring these children for many years to come, and finally Prof. Shoshana Ravel-Wilk, Pediatric Hematologist from Shaare Zedek, presented the existing protocols in leading international hospitals and proposed the first similar protocol for Israel.

About 100 doctors attended the convention, and the organizers hope they will "spread the word" among pediatricians and ER and trauma teams all over the country.