Stroke in Children: Rare but Real

Childhood stroke is seen less frequently, but it can have profound effects on kids, often leading to significant health challenges. The causes vary and differ from those seen in adults. There's still a lot to learn about strokes in children. It's crucial for doctors working with young patients to recognize the signs of a stroke at any age so they can provide appropriate care, helping the brain heal and function better. The World Health Organization (WHO) defines stroke as "a clinical syndrome consisting of rapidly developing clinical signs of focal (global in case of coma) disturbance of cerebral function lasting more than 24 hours or leading to death with no apparent cause other than a vascular origin."

Type of Stroke Based on a Child's Age:

Perinatal Stroke: It happens between 28 weeks of pregnancy and the first 28 days after birth. There are two main types within this category. Acute perinatal strokes occur right at or soon after birth and can show up as focal seizures or changes in consciousness. On the other hand, presumed perinatal strokes are chronic problems identified later on, believed to have happened during the earlier period.

Childhood Stroke: Occurs from 28 days after birth up until the age of 18. Ischemic stroke in children happens in about 1 to 2 out of every 100,000 kids each year in developed Western countries. The risk is most significant for infants and kids under 5, and it affects boys more often than girls. Also, Black and Asian children tend to experience strokes more frequently than white children.

How Common is Stroke in Children?

Studies show there are about 1 to 2 cases of stroke for every 100,000 kids under 18 each year. For newborns, the rate is roughly one perinatal stroke for every 3,500 live births. It's important to note that these figures can be tricky to pinpoint because diagnosing strokes can be pretty challenging.

What are the Risk Factors in Children for Stroke?

Risk factors include both maternal and neonatal factors. Normal activation of coagulation factors in the mother and low levels of factors in the infant just before and after the time of delivery may add to the increased stroke risk in neonates.

Neonatal Risk Factors:

Congenital heart diseases
Blood clotting disorder
Lack of oxygen during birth
Infection
Trauma
Genetic syndrome, e.g., Down syndrome.
Cardiac defects
Brain or Neck injury

Maternal Risk Factors:

History of infertility
Premature rupture of membranes
Emergency cesarean section
Gestational or delivery complications
Dehydration
Traumatic Brain Injury
Infection
Obesity
High blood pressure

Common Signs and Symptoms of Stroke in Children:

Seizure
One-sided weakness (hemiparesis)
Irritability (Ataxia)
Sensory loss
Changes in behavior and thinking
Swallowing difficulty (dysphagia)
No neck control in the early ages
Affects ability to communicate (aphasia)
Vision and hearing loss
Cognitive changes or problems with memory, judgment, focus and problem solving
Learning disabilities, including poor attention skills

Various Imaging Tests are Used to Diagnose a Stroke in Children:

CT scan (computed tomography scan): It is often the first choice, as it quickly reveals any bleeding in the brain. If more detail is needed, an MRI provides a detailed look at your child's brain and blood vessels, making it the best test for spotting a stroke.
MRI (magnetic resonance imaging): To check the blood vessel lesions.
MRA (magnetic resonance angiogram): which shows how blood flows in the brain. Additionally, to understand the reasons behind.
Echocardiogram (ECG): To check the heart anatomy.
Electroencephalogram (EEG): To see if seizures are happening, and blood tests to rule out conditions like sickle cell disease or issues that could lead to blood clots.

Management of Stroke in Children:

Antibiotics
Corticosteroid
Blood transfusion
Opening blocked vessels through medications or surgeries
Blood-thinning medication
Prevent high pressure in the brain

Every kid's journey is different. It's essential to have a multidisciplinary team that includes an occupational and physical therapist, a speech therapist, a neuropsychologist, a social worker, school officials, and a nutritionist. Together, they make a customized recovery plan. After a child has a stroke, they might face challenges like weak muscles, tight muscles, difficulty swallowing, issues with thinking, trouble speaking and balance.

Strokes in children are challenging to diagnose because the symptoms are often subtle, which can lead to easy misdiagnosis. It is crucial to thoroughly assess a child's neurological health, examine their symptoms, and utilize radiological tests for an accurate diagnosis. Getting this diagnosis quickly is essential. It can lead to better long-term outcomes and reduce the risk of severe neurological issues that could develop if a stroke is treated incorrectly.

Know more about: Brain Stroke Signs and Symptoms You Should Never Ignore