Stroke in Children
A stroke is a brain injury caused by the interruption of blood flow to part of the brain. Stroke can be caused by a blocked blood vessel (ischemic stroke) or by bleeding in the brain (hemorrhagic stroke). The brain needs a constant supply of oxygen, which is carried by the blood. When blood flow stops, brain cells start to die.
Stroke is much more common in adults than children. Because a stroke isn't expected in a child, the diagnosis may be delayed. A child, however, often recovers more easily than an adult because a child's brain is still developing. The risk of stroke is highest before the age of one and is one of the top 10 causes of death in children.
Risk factors for stroke in children
Some conditions put children at an increased risk for stroke.
Heart problem (most common)
Sickle cell disease (a blood disorder)
Infection (such as meningitis, encephalitis)
Some metabolic disorders
Blood clotting problems
Blood vessel abnormalities (dissection, vasculitis)
High blood pressure
In many children, no cause can be found.
Symptoms of stroke in children
Symptoms of stroke in children depend on the age of the child and the cause of the stroke. In newborns you might see:
Extreme sleepiness or altered mental status
Tendency to use only one side of the body
In young children, the diagnosis is often delayed. In older children, stroke symptoms are more like the symptoms seen in adults and may include:
Severe headache, possibly with vomiting
Trouble with vision or moving the eyes
Weakness or numbness on one side of the body or face
Dizziness or sudden confusion
Trouble walking or loss of balance or coordination
Trouble speaking or understanding words or sentences
Sleepiness or loss of consciousness
Seizure or paralysis of one part of the body
If your child has symptoms of stroke, call 911 or your local emergency number.
F.A.S.T. is an easy way to remember the signs of a stroke. When you see the signs, you will know that you need to call 911 fast.
F.A.S.T. stands for:
F is for face drooping - One side of the face is drooping or numb. When the person smiles, the smile is uneven.
A is for arm weakness - One arm is weak or numb. When the person lifts both arms at the same time, one arm may drift downward.
S is for speech difficulty - You may notice slurred speech or difficulty speaking. The person can't repeat a simple sentence correctly when asked.
T is for time to call 911 - If someone shows any of these symptoms, even if they go away, call 911 immediately. Make note of the time the symptoms first appeared.
Diagnosis of stroke in children
Diagnosis begins with a review of your child's current symptoms and health history. The health care provider will ask about injuries, infection, problems with growth and development, and about family history of bleeding problems. The health care provider will examine your child. He or she will look for any signs of weakness, numbness, or other signs of stroke. Several tests may be done to help make the diagnosis:
Brain imaging studies. Brain magnetic resonance imaging (MRI) is the test of choice for stroke diagnosis in children. Computed tomography (CT) scans are a good option if MRI is not available. Magnetic resonance angiography (MRA) may also be done as part of the MRI. Transcranial doppler or ultrasound of the brain may be done to look for abnormalities of brain blood vessels.
Blood tests. Blood is tested for signs of infection, sickle cell disease, inflammation of blood vessels, and blood clotting abnormalities.
Heart and blood vessel studies. Heart rhythm is checked with an electrocardiogram (ECG). A special ultrasound of the heart may be done to look for the heart for possible causes of air embolism or blood clot. A special monitor may also be worn to look for heart rhythm abnormalities over a prolonged time.
Lumbar puncture. Fluid surrounding the brain and spinal cord (cerebrospinal fluid) may be checked for blood or signs of infection.
Electroencephalogram or EEG. This is done to look for seizures.
Pulse oximetry. This helps make sure there is enough oxygen in the blood.
Treatment of stroke in children
It is important to call 911 at the first sign of stroke. Treatment works best if it is started as soon as possible after a stroke occurs. Treatment depends on the cause of the stroke. Treatment may include:
Intravenous (IV) fluids to avoid or reverse dehydration. Other treatment includes:
Medicines to treat blood clots and to thin blood
Surgery for some specific causes
Prevention of stroke in children
In children, the first symptom of a stroke is usually the first warning, so there may be no way to prevent the first stroke. Some children may have a second stroke. Your child's health care provider will treat the condition that may have led to the stroke. Medicines, procedures, and surgery may be part of the treatment.
Managing stroke in children
Most children recover following stroke. After the initial treatment, your child will receive physical, occupational, and rehabilitation therapy.
The most common problem is loss of movement on one side of the body. Your child may also need help with learning, speech, vision, and behavior problems.
January 10, 2018
Ischemic stroke in children: Evaluation, initial management, and prognosis, Up To Date
Bass, Pat F. III, MD, MPH,Sudheendra, Deepak, MD