Childhood stroke, though less commonly discussed than adult stroke, represents a significant medical event that can affect infants, children, and adolescents. Each year, approximately 11 in 100,000 children from birth through age 18 experience a stroke, with the highest incidence occurring during the first year of life. This article aims to provide accessible information on childhood stroke, covering its definition, various signs across different age groups, underlying causes, and the general approaches to treatment and recovery.
Understanding Childhood Stroke
A stroke occurs when the blood supply to a part of the brain is interrupted, leading to brain cell death. This interruption can happen in two primary ways: an ischemic stroke, where blood flow is blocked, or a hemorrhagic stroke, involving bleeding in the brain. Ischemic stroke is the most common type of childhood stroke, often resulting from a blood clot forming in an artery supplying the brain, or traveling there from elsewhere in the body.
Hemorrhagic stroke, while less common in children, occurs when a blood vessel in the brain ruptures, causing blood to leak into brain tissue and interfere with normal blood flow. Unlike adult strokes, childhood strokes often have different underlying causes and unique symptoms. The impact of a stroke on a child can vary based on its type, size, and location within the brain.
Recognizing the Signs
Recognizing the signs of stroke in children can be challenging because symptoms vary significantly with age and may not always mirror those seen in adults. Prompt identification and medical attention are important to help minimize brain damage.
Neonates and Infants
In newborns (birth to 28 days) and infants, stroke symptoms can be subtle. These may include focal seizures affecting one side of the body, extreme sleepiness or lethargy, a noticeable preference for using only one side of their body, difficulty with feeding, or a weak sucking reflex. Unusual eye movements or a lack of responsiveness to stimuli may also be observed.
Toddlers and Preschoolers
As children enter the toddler and preschool years, signs of stroke become more apparent. These include sudden weakness or numbness affecting one side of the body, difficulties with walking, or problems with balance and coordination. Speech issues, such as slurred speech or trouble understanding spoken words, also emerge.
School-Aged Children and Adolescents
For school-aged children and adolescents, stroke symptoms resemble those seen in adults. These manifest as sudden weakness or numbness, facial drooping, changes in vision (such as blurred or double vision), or severe headaches, possibly accompanied by vomiting. Difficulty speaking clearly, understanding speech, or sudden confusion are common presentations. If any of these signs are noticed, immediate medical attention, typically by calling emergency services, is recommended.
Identifying the Causes
The causes of childhood stroke are diverse. In many instances, the specific cause can be challenging to pinpoint. Various underlying conditions and risk factors contribute to stroke occurrence in pediatric populations.
Common causes and risk factors include:
- Congenital or acquired heart conditions, which can lead to blood clots traveling to the brain.
- Blood disorders, such as sickle cell disease (increasing stroke risk for at least 10% of affected children) and other clotting disorders.
- Infections like meningitis or varicella (chickenpox).
- Vascular abnormalities, such as moyamoya disease (where brain blood vessels narrow and develop abnormal networks) or arteriovenous malformations (AVMs), which are tangles of abnormal blood vessels.
- Head or neck trauma, leading to blood clots or vessel damage.
- Certain genetic conditions.
In some cases, despite thorough investigation, the exact cause of a child’s stroke may remain unknown.
Treatment and Recovery
The general approach to treating childhood stroke involves immediate medical management followed by comprehensive rehabilitation. Acute treatment focuses on stabilizing the child and minimizing brain damage. This can involve administering medications to manage blood pressure, control seizures, or using blood thinners like aspirin. Surgical interventions may also be necessary, particularly for hemorrhagic strokes or to address underlying vascular abnormalities.
Rehabilitation is an important part of the recovery journey for children who have experienced a stroke. This often includes physical therapy (PT) to improve movement and strength, occupational therapy (OT) to enhance daily living skills, and speech-language pathology (SLP) to address communication and swallowing difficulties. The developing brain’s plasticity, or its ability to reorganize and adapt, can significantly aid in a child’s recovery, often allowing for substantial improvements over time. Long-term support is also provided, encompassing ongoing medical follow-up, psychological assessment to address cognitive and language deficits, and educational support to help children reintegrate into school and achieve their developmental milestones.