The neuropediatrician and member of the Pediatric Stroke Working Group of the Spanish Society of Pediatric Neurology (SENEP), Dr. Cristina Villar, has insisted on the need to implement the pediatric stroke code (CIP) uniformly throughout the autonomous territory, recalling that "the first 24 hours are key".
She has underlined that "children also suffer strokes, although their cause differs from that of adults", since "in minors, it is not due to obesity, high cholesterol or hypertension, but rather as a result of congenital or acquired arteriopathies, heart diseases, or in relation to an infection", and she has stressed that "in addition, in these cases, diagnosis and treatment must be carried out before 24 hours, as reflected in the latest international recommendations".
Coinciding with the commemoration of World Stroke Day, this Thursday, October 29, Villar has denounced that the CIP is only currently operating in 10 autonomous communities, which "generates inequalities in the care of these minors depending on the place where they live". In her view, "it is a determining protocol when facing a phenomenon with an estimated incidence of 1.3 to 13 cases per 100,000 children per year, which represents one of the 10 main causes of death in childhood and which associates neurological sequelae in the long term in more than 60 percent of survivors".
As she has explained, "the functional prognosis of these children depends critically on the immediate initiation of reperfusion treatments, something that is currently not being carried out in many Spanish communities, and which is included in the protocols set by the CIP", in addition to the fact that this "establishes a coordinated and urgent clinical and care alert system, in which, upon clinical suspicion by a physician, the different transport systems are activated, as well as urgent, coordinated and efficient radiological diagnosis and treatment, in order to minimize the sequelae that may occur in the short, medium, and long term".
In a structured survey conducted between August 2025 and May of this year among neuropediatricians at reference public hospitals in the 17 autonomous communities, Villar found that the CIP is operational in Madrid, Catalonia, Valencian Community, Basque Country, Navarra, La Rioja, Aragón, Extremadura, Murcia and the Balearic Islands. "It is lacking in Galicia, Asturias, Cantabria, Castilla y León, Castilla-La Mancha and in the Canary Islands," while "Andalusia is about to approve the stroke code".
First step for an adequate diagnosis
Villar emphasizes that the existence of this protocol "is the first necessary step for a good diagnosis and treatment of these cases", warning that "without its implementation, these patients will see their diagnosis delayed and, by the time it is achieved, it is possible that it will no longer be time to treat the minors". In this regard, he laments that "it is not fair that this changes because you do not live in a city with a reference stroke hospital or that in the year 2026 an urgent magnetic resonance imaging scan cannot be performed on a child with an acute neurological disorder".
He likewise considers it essential to accompany the CIP with "sufficient means to develop it efficiently", such as "sufficient and trained on-call professionals for its management, available transport systems, effective technical means for diagnosis (ideally brain magnetic resonance imaging) and hyperacute treatment". The neuropediatricians consulted agree that the main obstacles to putting the CIP into operation and maintaining it are concentrated in the lack of technical and human resources, in geographical dispersion and in the absence of clear and homogeneous protocols throughout the country.
Villar also stresses that, although in Madrid, Navarra, Cantabria and La Rioja patients can reach a center with magnetic resonance imaging and advanced therapeutic capacity 24 hours a day in less than an hour, the lack of funded neurorehabilitation after pediatric stroke persists in many regions, something he defines as "another cornerstone of treatment in the first 6-12 months after the stroke".
Finally, he recalls that "in the management of pediatric stroke, the neuropediatrician has both the experience from Pediatrics, which helps in the examination of the child and in knowing the most important pediatric differential diagnoses, and the training in vascular pathology of the nervous system, for decision-making together with the radiologist and the rest of the specialists involved".