News: New stroke guidance including first pediatric guidance released by AHA, ASA

The American Heart Association (AHA) and American Stroke Association (ASA) have released the 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke, published recently in Stroke. The guidance updates eligibility for acute stroke therapies and outlines the first formal recommendations for diagnosing and treating stroke in children, Medscape Medical News reported.

The 2026 guideline replaces the 2018 edition and its 2019 update in order to reflect all the new evidence that has reshaped acute ischemic stroke care, including interventions for large vessel occlusion, thrombolysis, endovascular thrombectomy, and streamlined hospital workflows.

“New recommendations in the guideline expand access to cutting-edge treatments, such as clot-removal procedures and medications, simplify imaging requirements, so more hospitals can act quickly and introduce guidance for pediatric stroke for the first time,” said Shyam Prabhakaran, MD, chair of the Department of Neurology at the University of Chicago Medicine in Chicago, and chair of the AHA/ASA writing group, in a statement.

The update also includes guidance on pediatric stroke care for the first time. Besides warning signs similar to adults, signs in infants, children, and teens may also include the following:

• Sudden severe headache, especially with vomiting and sleepiness
• New onset of seizures, typically on one side
• Sudden confusion
• Trouble speaking or understanding others
• Sudden trouble seeing in one or both eyes
• Sudden difficulty walking
• Dizziness
• Loss of balance or coordination 

The guideline points out that currently available stroke screening tools have been developed for adults and fail to accurately distinguish stroke from events with similar symptoms in the pediatric population, such as migraine, seizure, traumatic brain injury, or brain tumor. 

“These recommendations represent a major step toward standardized, evidence-based care for children. They also highlight how much more we still need to learn about pediatric stroke,” Prabhakaran said.

Editor’s note: To read Medscape Medical News’ coverage of this story, click here. To read the updated guidance, click here.