Childhood stroke

Even though it seems unthinkable, children can have strokes, too! Adult strokes are often caused by high blood pressure, high cholesterol, a history of smoking, too much alcohol and obesity. Children’s strokes, on the other hand, are often caused by birth defects, infections (e.g. meningitis, encephalitis), trauma, and blood disorders such as sickle cell disease.

Children who have suffered a stroke may often have problems with speech and communication (aphasia and dysphagia) as well as visual problems such as trouble with visual perception. There are stroke-related disabilities that are unique to children such as cerebral palsy, mental retardation and epilepsy.

Some common complications for children who have suffered a stroke are: fever, change of mental status (i.e.- loss of emotional control; changes in memory, judgment or problem solving); changes in behavior such as improper language or actions; poor nutrition and conditions that result from prolonged bedrest.

20 – 35% of infant stroke survivors will go on to have another stroke, and more than two-thirds of survivors will have cognitive deficits, physical disabilities that require therapy, or seizures treated by medication or surgery.

What causes ischemic stroke in children?

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 stroke1. There is a high risk of repeat strokes, but this can be reduced by blood transfusion.

Finally, ischemic strokes can be caused by trauma that injures large arteries and causes a loss of blood flow. For instance, a large artery might be injured when a child has a neck injury

What causes hemorrhagic stroke in children?

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.

Will my child get better?

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.

While strokes in children can be devastating, children have a better ability to heal than an adult. A child’s brain is still developing and may have a greater ability to repair itself. With the help of physical and speech therapy, most childhood stroke survivors recover the use of their arms, legs and speech. At St. John's Hospital, we have an expert team of therapists to help a child recover as much function as possible.

What can you do to help to help control your child’s risk factors for stroke?

You can’t control certain risk factors for heart disease and stroke such as age, sex, race and family medical history but there are other risk factors you can control, treat or prevent:

The incidence of stroke in children is relatively low; about six cases in every 100,000 children per year and at least one-third of those cases are in newborns. Strokes are slightly more common in children under the age of two.

Smoking and exposure to tobacco smoke- Smoking is a hard habit to break, that’s why it’s important that your children never start. The earlier people start smoking, the greater the risk to their future health. Set a good example for your children by not smoking. If you do smoke, don’t smoke around your children. Get help to quit smoking. Your risk of heart disease and stroke decrease as soon as you stop smoking.

Physical inactivity- Keeping your children active and fit will help them control their weight and blood cholesterol levels, and lower their risk for developing diabetes and obesity. If your child is overweight encourage daily activities, starting with 10 minutes per day and adding more each day. Limit the amount of time your child spends being inactive, such as watching television, playing on the computer, etc, to no more than one to two hours per day. Only 30% of males and 26% of females in grades 9-12 attend physical education classes on a daily basis. Lack of physical activity can also contribute to becoming overweight and developing high blood pressure or diabetes. Overweight children are at high risk for becoming overweight adults, as well as developing diabetes, having premature heart disease or stroke. Over 9 million children between the ages 6-19 are overweight.

Eating a diet low in saturated fat and cholesterol- Read food labels and choose foods that heart healthy. For example, choose lower fat milk, eat more fruits and vegetables, and include more servings of whole-grains or other complex carbohydrates in your child’s diet.

High Blood Pressure (hypertension)- High blood pressure causes the heart to work harder than normal and over time this can lead to heart failure or stroke. Children with high blood pressure often have no symptoms. They can look and feel great without even knowing they have hypertension. Make sure that your child’s blood pressure is measured yearly beginning at age 3 by a doctor, school nurse or local health clinic staff.

Diabetes Mellitus- Diabetes mellitus is a disease in which the body doesn’t make or respond properly to the hormone insulin, which the body needs to convert sugar, starches and other foods into energy. Untreated diabetes can lead to many serious medical problems including heart and blood vessel disease. If your child has diabetes make sure that he/she has regular medical check ups to control it; work with your child’s doctor to improve your child’s eating habits and ensure that he/she exercises regularly and maintains a healthy weight.

Signs and Symptoms of Childhood Stroke:

Severe headache- this is often the first complaint
Nausea and/or vomiting/ warm, flushed, clammy skin
Slow, full pulse – may have distended neck veins
Speech difficulties- absent, slurred or inappropriate speech
Eye movement problems – partial or complete blindness, blurred vision, unequal pupils
Numbness – paralysis, weakness, or loss of coordination of limbs, usually on one side of the body; loss of balance
Facial droop or salivary drool
Urinary incontinence
Seizures
Brief loss of consciousness; unconscious ‘snoring’ respirations
May show signs of rapid recovery (TIA)

The Children's Hemiplegia and Stroke Association (CHASA) is volunteer-based nonprofit  organization founded by parents of children with hemiplegia in 1999 to provide assistance, information and counseling to families of children who have hemiplegia, hemiparesis, or hemiplegic cerebral palsy. Often, these conditions are caused by stroke in an infant. CHASA provides three informational websites, an e-mail discussion group with over 1500 members, plans and hosts an annual retreat and medical conference for families of children who have hemiplegia,  supports local family events, funds pilot research studies, provides family retreat scholarships, and provides college scholarships for young adults who have hemiplegia.