Like most people, you probably think that strokes only happen in adults — especially older adults. But kids can have strokes, too. Although they’re less common in kids, strokes occur in children of all ages, even those who haven’t been born yet.
About Strokes
A stroke is a biological event (sometimes called a “brain attack”) that happens when blood flow to the brain stops, even for a brief second.
Blood carries oxygen and other nourishing substances to the body’s cells and organs, including the brain. When an ischemic stroke occurs, these important substances can’t get to the brain and brain cells die. This can permanently damage the brain and cause a person’s body to no longer function normally.
A common cause of ischemic strokes is that a blood clot forms in the heart and travels to the brain. This can be caused by congenital heart problems such as abnormal valves or infections. In these cases children may need surgery or antibiotics.
Sickle cell disease is a blood disorder that’s associated with ischemic stroke. In sickle cell disease, the blood cell can’t carry oxygen to the brain, and blood vessels leading to the brain may have narrowed or closed. About 10 percent of children with sickle cell disease suffer a stroke. There is a high risk of repeat strokes, but this can be reduced by blood transfusion.
Strokes also can happen when a blood vessel in the brain breaks, flooding the brain with blood and damaging brain cells. This type of stroke is known as a hemorrhagic stroke. When a blood vessel on or in the brain ruptures, blood flows into brain areas where it’s not supposed to go. It may pool in brain tissues, resulting in a blood clot. Also, because the vessel is ruptured, blood isn’t transported where it should go. As a result, the brain is deprived of oxygen, and this may lead to permanent brain injury. Hemorrhagic strokes are most often caused by rupturing or weakened or malformed arteries known as AVMs (arteriovenous malformations). The risk of hemorrhage is higher with certain illnesses such as hemophilia.
Strokes in children most often happen between the 28th week of pregnancy, before a child is born, and 1 month after birth. Because they occur during the time surrounding birth, they’re sometimes called perinatal strokes. Perinatal strokes usually occur during delivery or right after delivery because the baby doesn’t get enough oxygen while traveling through the birth canal.
Strokes also can occur in older kids but are usually caused by another condition that stops the flow of blood to the brain or causes bleeding in the brain.
Causes
Determining the cause of a stroke in a child can be difficult. If your child has had a stroke, the doctor might not have definite answers for you, but can tell that a stroke occurred by using medical tests. About one third of all childhood strokes aren’t related to any disease, condition, or injury that’s known to increase the risk of stroke.
Ischemic strokes, the most common type in children, are usually related to:
- lack of oxygen during birth
- a heart defect present at birth
- blood disorders such as sickle cell anemia, a disease that destroys blood cells and blocks blood vessels
- injury to an artery (a blood vessel that brings oxygen) in the brain
- dehydration
- genetic disorders like Moyamoya, a rare disease that affects arteries in the brain
- an infection, such as meningitis or chickenpox
Certain problems that affect a mother during pregnancy can also cause a baby to have an ischemic stroke before or after birth. Examples include:
- preeclampsia (high blood pressure during pregnancy that can cause swelling in the hands, feet, and legs)
- premature rupture of the membranes (when a woman’s water breaks more than 24 hours before labor starts)
- diabetes
- infections
- drug abuse
- placenta problems that decrease the baby’s oxygen supply, such as placental abruption
Hemorrhagic strokes can be caused by:
- a head injury that results in a broken blood vessel
- arteriovenous malformation, a condition in which the blood vessels in the brain don’t connect properly
- an aneurysm (weakness in an artery wall)
- diseases that affect blood clotting, such as hemophilia
Diagnosis
Perinatal and early childhood strokes can sometimes be hard to diagnose, especially if a child has no obvious signs or symptoms. In some cases, a stroke is found to be the cause of seizures or developmental delays only after many other conditions have been ruled out. This might mean that a child will undergo several tests before the doctor even mentions the word “stroke.”
If stroke is suspected, a doctor will probably want the child to undergo one or more of these medical tests:
- blood tests
- magnetic resonance imaging (MRI), a safe and painless test that uses magnets, radio waves, and computer technology to produce very good pictures of internal body parts, such as the brain
- magnetic resonance angiography (MRA), an MRI of specific arteries
- magnetic resonance venography (MRV), an MRI of specific veins
- computed tomography scan (CT or CAT scan), a quick and painless test that produces pictures of bones and other body parts using X-rays and a computer
- computed tomography angiography (CTA), an X-ray of specific arteries
- cranial ultrasound, high-frequency sound waves that bounce off organs and create a picture of the brain
- lumbar puncture, also called a spinal tap
Treatment
Treatment for a stroke is determined by how old the child is, what signs and symptoms he or she experiences, which area of the brain is affected, how much brain tissue was damaged, and whether another ongoing condition was the cause of the stroke.
Many different treatments are possible. For example, a child who is having seizures may require anti-seizure medications, whereas a child with a heart defect might need medication to thin the blood. For most kids, treatment also involves age-appropriate rehabilitation and therapy.
Recovery from stroke is different with each child. Prompt medical treatment and rehabilitation therapy can maximize recovery. In general, most younger people will recover more abilities than older people. Children often recover the use of their arms and legs and their ability to speak after a stroke.
What are the effects of stroke in children?
The effects of stroke in a child are generally the same as in an adult. The most common effects are:
- Hemiparesis (weakness on one side of the body), or hemiplegia (paralysis on one side of the body).
- One-sided neglect (unilateral neglect), which causes the stroke survivor to ignore or forget their weaker side.
- Aphasia (difficulty with speech and language), or dysphagia (trouble swallowing).
- Decreased field of vision and trouble with visual perception.
- Loss of emotional control and changes in mood.
- Cognitive changes or problems with memory, judgment and problem-solving.
- Behavior changes or personality changes, improper language or actions.
Complications
The brain damage that occurs during a stroke can cause a number of other problems that could affect a child throughout life, including:
- cerebral palsy
- mental retardation
- paralysis or weakness on one side
- communication problems
- vision deficits
- psychological difficulties
Kids who’ve had a stroke will see doctors who specialize in helping people cope with these problems. These specialists might include occupational, physical, and speech therapists. A child’s care might be overseen by a neurorehabilitation specialist, a doctor who uses many different types of therapy to help children recover from stroke.
Source: AHA and KidsHealth