avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2020-10-1-21-30avk-995Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESИнсульт у детей и подростков: актуальные проблемы догоспитальной диагностикиStroke in children and adolescents: topical problems of pre-hospital diagnosticsХачатуровЮ. А.KhachaturovY. A.

Москва

Moscow

ЩедеркинаИ. О.ShchederkinaI. O.

Москва

Moscow

ПлавуновН. Ф.PlavunovN. F.

Москва

Moscow

СидоровА. М.SidorovA. M.

Москва

Moscow

ПетряйкинаЕ. Е.PetryaykinaE. E.

Москва

Moscow

ВитковскаяИ. П.VytkovskayaI. P.

Москва

Moscow

КадышевВ. А.KadyshevV. A.

Валерий Александрович Кадышев

Москва

Valery A. Kadyshev

Moscow

damask51@rambler.ruГБУЗ «Морозовская Детская городская клиническая больница Департамента здравоохранения города Москвы»РоссияMorozov Children’s City Clinical Hospital of Moscow Healthcare DepartmentRussian FederationГБУ «Станция скорой и неотложной медицинской помощи им. А.С. Пучкова»; ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава РФРоссияFirst aid station named after A.S. Puchkov; Federal State Budget institution of Higher Education «A.I. Evdokimov Moscow State University of Medicine and Dentistry»Russian FederationГБУЗ «Морозовская Детская городская клиническая больница Департамента здравоохранения города Москвы»; ФГАОУ ВО «Российский Университет дружбы народов» Министерства науки и высшего образования РФРоссияMorozov Children’s City Clinical Hospital of Moscow Healthcare Department; Peoples Friendship University of RussiaRussian FederationГБУЗ «Морозовская Детская городская клиническая больница Департамента здравоохранения города Москвы»; ГБУ «Научно-исследовательский институт организации здравоохранения и медицинского менеджмента Департамента здравоохранения города Москвы»РоссияMorozov Children’s City Clinical Hospital of Moscow Healthcare Department; Research Institute of Health Care Organization and Medical Management of Moscow Healthcare DepartmentRussian Federation2020300120201012130Copyright © Хачатуров Ю.А., Щедеркина И.О., Плавунов Н.Ф., Сидоров А.М., Петряйкина Е.Е., Витковская И.П., Кадышев В.А., 20202020Хачатуров Ю.А., Щедеркина И.О., Плавунов Н.Ф., Сидоров А.М., Петряйкина Е.Е., Витковская И.П., Кадышев В.А.Khachaturov Y.A., Shchederkina I.O., Plavunov N.F., Sidorov A.M., Petryaykina E.E., Vytkovskaya I.P., Kadyshev V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/995

Статья посвящена актуальной проблеме педиатрии и детской неврологии — догоспитальной диагностике инсульта у детей. Представлен обзор отечественной и зарубежной литературы, посвященной ранней диагностике острых нарушений мозгового кровообращения у детей и подростков, а также эпидемиологические данные по педиатрическому инсульту. Особое внимание уделено особенностям симптоматики инсульта и инсультоподобных состояний («масок инсульта») в педиатрической популяции, и анализу основных факторов, влияющих на ошибки в ранней диагностике инсульта у детей и подростков. В настоящее время при диагностике ишемического инсульта его «маски» встречаются в 53,9 % случаев, при геморрагическом инсульте — в 36,3 %, при транзиторных ишемических атаках — в 9,8 % случаев. Одно из наиболее частых заболеваний, с которым необходимо дифференцировать ишемический инсульт у детей — это мигрень. Этой проблеме посвящены работы, которые выделяют ведущие дифференциально-диагностические критерии мигрени и инсульта, а также представляют диагностический алгоритм. Клинические особенности педиатрического инсульта, особенно манифестных симптомов, затрудняют использование взрослых скрининговых инсультных шкал взрослых в педиатрии. В статье рассмотрены основные шкалы ранней диагностики инсульта у взрослых, их возможное применение в педиатрической практике. Накопленный в настоящее время опыт догоспитальной и ранней диагностики инсульта у детей определяет основные направления работы по сокращению времени постановки диагноза острого нарушения мозгового кровообращения у детей, с последующим внедрением в педиатрическую практику реперфузионной терапии.

The article is devoted to the urgent problem of pediatrics and pediatric neurology, pre-hospital diagnosis of stroke in children. A review of domestic and foreign literature on the early diagnosis of stroke in children and adolescents, as well as epidemiological data on pediatric stroke, is presented. Particular attention is paid to the features of the symptoms of stroke and stroke-like conditions («stroke masks») in the pediatric population and the analysis of the main factors that influence errors in the early diagnosis of stroke in children and adolescents. Currently, in the diagnosis of ischemic stroke, its «masks» are found in 53.9 % of cases, with hemorrhagic stroke, in 36.3 %, and with transient ischemic attacks, in 9.8 % of cases. One of the most common diseases with which it is necessary to differentiate ischemic stroke in children is migraine. This problem is covered in academic writings that highlight the leading differential diagnostic criteria for migraine and stroke, and also represent a diagnostic algorithm. The clinical features of pediatric stroke, especially manifest symptoms, make it difficult to apply adult screening stroke scales in pediatrics. The article discusses the main scales for the early diagnosis of stroke in adults, and their potential application in pediatric practice. Currently accumulated experience in prehospital and early diagnosis of stroke in children determines the main directions of work to reduce the time of diagnosis of acute cerebrovascular accidents in children, followed by the introduction of reperfusion therapy in pediatric practice.

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The authors declare that there are no conflicts of interest present.