Children have strokes, too—new guidelines will help diagnosis
IF YOU SUSPECT YOUR CHILD IS HAVING A STROKE, CALL EMERGENCY IMMEDIATELY.
What is pediatric stroke?
Pediatric stroke is a rare condition affecting one in every 4,000 newborns and an additional 2,000 older children each year. Stroke is a type of blood vessel (cerebrovascular) disorder. Strokes can be categorized as ischemic (caused by insufficient blood flow) and hemorrhagic (caused by bleeding into the brain). When a blood vessel in the brain is injured, the brain tissue around it loses blood supply and suffers injury as well. Treatments and long-term outcome in children are different for each type.
As with adults, without prompt and appropriate treatment, stroke in children can be life threatening and requires immediate medical attention. Stroke is among the top 10 causes of death in children. Pediatric stroke can also cause neurologic disability, with a risk of permanent long-term cognitive and motor impairment.
What are the signs and symptoms of pediatric stroke?
Stroke in children typically begins suddenly. Symptoms may include (but are not limited to) the following:
- weakness or numbness on one side of the body
- slurred speech or difficulty with language
- trouble balancing or walking
- vision problems, such as double vision or loss of vision
- sudden lethargy or drowsiness
- seizure (unusual rhythmic movement of one or both sides of the body)
What are the risk factors for pediatric stroke?
Causes of stroke in children are different than those in adults. Risk factors include:
- heart disease
- problems with blood vessels supplying the brain
- blood clotting disorders
- sickle cell disease
Pediatric Stroke Diagnosis
When a child experiences symptoms that may indicate a stroke, rapid and thorough evaluation by a pediatrician or neurologist is essential to initiate treatment quickly and lower the risk of long-term problems. Imaging studies of the brain and blood vessels, such as magnetic resonance imaging (MRI) or computed tomography (CT), are essential for diagnosis.
Additional testing to find the cause of the stroke may include:
- catheter angiogram (a thin, flexible tube is inserted into blood vessels, contrast is injected, and X-rays are used to take pictures of the arteries and veins in the brain)
- echocardiogram (an ultrasound of the heart)
- blood tests for clotting disorders
Your child may need to see other specialists to help identify the cause of the stroke, including intensive care doctors, hematologists (specialists in blood disorders), neurologists, neurosurgeons, interventional radiologists and rehabilitation doctors (specialists in rehabilitation to recover function after stroke).
Pediatric Stroke Treatment
In the early stages of a stroke, your child’s treatment centers around supporting blood flow to the brain. Treatment may be a combination of the following:
Your child may receive aspirin or other blood thinners (anticoagulants) and special vitamins. Children with sickle cell disease and stroke may be treated with hydroxyurea, transfusion therapy or both. If the stroke is causing seizures, your child may need anti-seizure medication as well.
“Clot-busting” medications used successfully in adults have not yet been approved for use in children, but they may be considered in certain situations.
If your child has abnormal connections in blood vessels that feed the brain (arteriovenous malformation) or blood vessels with weakened walls that can bulge and tear (aneurysm), the doctor may place a catheter inside the affected blood vessel to help repair the abnormal area. In some situations, a catheter can be used to remove large clots in blood vessels to help restore essential blood flow to the brain. These interventional neuroradiology procedures are done with a catheter that is inserted into a blood vessel in the arm or leg and guided into the blood vessels in the brain.
A surgical procedure may be appropriate for certain types of stroke and other cerebrovascular disorders. The type of surgery needed depends on the cause of the stroke. Surgery to remove a piece of bone (craniectomy) may be required in cases with severe brain swelling. Some other surgeries for stroke include closure of abnormal blood vessels, removal of abnormal areas of the brain and rerouting blood vessels to help provide blood supply to injured areas.
Pediatric Stroke Recovery
Follow-up care is extremely important. Once your child is stabilized, your medical team will work with you to create an ongoing plan to assess your child’s function and optimize recovery.
Depending on where in the brain the stroke occurred, your child may experience difficulties with walking, seeing, speaking or reading, sometimes with one side of the body affected more than the other. The stroke may cause a seizure disorder or have an impact on your child’s thinking or emotions.
Overall, a child’s growing brain has a better chance of recovering from stroke than an adult’s brain. Prompt diagnosis and treatment can minimize the risk of lasting problems, and early rehabilitation can help maximize recovery.
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