A pediatric stroke occurs when the blood supply to a part of the brain is disrupted, causing brain cells to be deprived of necessary oxygen and nutrients. This sudden event leads to injury of the brain tissue and is considered a medical emergency in infants, children, or adolescents. While stroke is often associated with older adults, it affects an estimated 2.5 to 13 per 100,000 children annually, and the diagnosis is often challenging due to non-specific symptoms. Prompt recognition and treatment are important to minimize the risk of lasting neurological problems.
Classification and Types
Pediatric stroke is categorized by the mechanism of injury and the timing of the event. The two primary types are ischemic and hemorrhagic strokes. Ischemic stroke, the more common type, happens when a blood clot or particle blocks a blood vessel in the brain, stopping blood flow to that area.
Hemorrhagic stroke involves bleeding into the brain tissue or surrounding spaces, resulting from a blood vessel rupture. The pooled blood damages brain cells and increases pressure within the skull. Unlike adults, who primarily experience ischemic strokes, children experience both ischemic and hemorrhagic strokes in roughly similar proportions.
Strokes are also defined by the patient’s age. Perinatal stroke occurs between 28 weeks of gestation and the first 28 days after birth. Strokes occurring after the first 28 days of life, up to 18 years of age, are classified as childhood strokes. This distinction is important because the causes and clinical presentation often differ significantly between these age groups.
Unique Causes and Risk Factors
The causes of stroke in children are often distinct from those in adults, who typically experience stroke due to atherosclerosis. In children, the risk is frequently tied to pre-existing medical conditions affecting the heart, blood, or blood vessels. Primary factors include congenital heart defects, which can lead to the formation of blood clots that travel to the brain or alter blood flow dynamics.
Blood disorders also pose a substantial risk. Sickle Cell Disease is a major cause of ischemic stroke, as this genetic disorder causes red blood cells to become rigid and crescent-shaped, easily blocking small blood vessels. Other risk factors include prothrombotic conditions that make the blood prone to clotting.
Vascular malformations, such as MoyaMoya disease, are another unique cause. This condition involves the narrowing of arteries at the base of the brain, forcing the development of a fragile network of smaller collateral vessels susceptible to blockage and rupture. Acute infections, including meningitis and chickenpox (varicella), can also trigger an inflammatory response that damages blood vessel walls, leading to stroke.
Recognizing the Signs
Recognizing the signs of pediatric stroke is challenging because symptoms are often subtle and may mimic common childhood illnesses. In older children, the presentation includes the sudden onset of focal neurological deficits, similar to adults. Observable signs include sudden weakness or numbness on one side of the body (hemiparesis), or difficulty with walking and coordination.
Speech and vision problems are also common, such as slurred speech, trouble understanding language, or sudden loss of vision. A severe headache, sometimes accompanied by vomiting, or sudden confusion can also indicate a stroke. These signs warrant immediate medical attention, as time is a primary factor in treatment.
In infants and neonates, symptoms are less obvious and often manifest as seizures, which are a common presentation of perinatal stroke. These seizures are often focal, affecting only one side of the body. Other subtle signs include extreme lethargy, sudden refusal to feed, or a noticeable preference for using only one side of the body, indicating weakness on the opposite side.
Treatment and Recovery Pathways
Acute treatment focuses on stabilizing the child and managing the immediate event, though options can be more limited than for adults. For ischemic strokes, clot-busting medications (thrombolytics) may be considered in a narrow window of time and specific circumstances. Supportive care, including adequate hydration and oxygen supply, is a standard approach for both ischemic and hemorrhagic strokes.
In hemorrhagic cases, acute care involves managing blood pressure and, occasionally, neurosurgical intervention to relieve pressure caused by the bleeding. Following the acute phase, the recovery pathway is centered on the developing brain’s unique ability to reorganize functions, known as neuroplasticity. This capacity is the foundation for long-term recovery and rehabilitation.
Rehabilitation is a multidisciplinary effort, often involving physical therapy to address motor skills and strength, and occupational therapy to help with fine motor skills and daily activities. Speech therapy is also a component, supporting the recovery of language and communication skills.