Strokes In Preteens: Understanding The Risk And Impact

Strokes can occur at any age, including in 11-year-olds. While strokes are rare in children, they are a life-threatening condition that requires immediate medical attention. A stroke occurs when the blood flow to the brain is interrupted, either due to a blocked blood vessel or bleeding in the brain. This interruption causes brain cells to die, resulting in potential brain damage and long-term physical and cognitive disabilities.

The risk factors for stroke in children include heart problems, sickle cell disease, infections, metabolic disorders, blood clotting problems, and blood vessel abnormalities. The symptoms of stroke in children vary depending on their age, but can include severe headaches, weakness or numbness, sudden confusion, vision problems, difficulty walking or speaking, seizures, and paralysis.

It is important to recognize the signs of stroke and seek immediate medical attention by calling emergency services. Prompt treatment can significantly improve a child's health and recovery.

What is a paediatric stroke?

A paediatric stroke is a stroke that occurs before the age of 18. It includes perinatal strokes, which a child can be born with, strokes before 28 days of life, and childhood strokes that occur after 28 days of life, before the age of 18.

A stroke is a life-threatening condition that happens when blood flow to the brain is interrupted or blocked. This can be due to blood clots or bleeding in the brain. In the former case, oxygen and other important substances are prevented from reaching the brain, causing brain cells to die. In the latter case, a blood vessel in the brain breaks, flooding the brain with blood and damaging brain cells.

Strokes in children most often happen within the first month after birth and are sometimes called perinatal or neonatal strokes. They usually occur during delivery or right after when the baby doesn't get enough oxygen while travelling through the birth canal. However, strokes can also affect older children, usually due to another condition that stops the flow of blood to the brain or causes bleeding in the brain.

The two types of stroke are:

• Ischemic stroke: caused by insufficient blood flow to the brain.
• Hemorrhagic stroke: caused by bleeding into the brain.

Strokes are rare in children, but when they do occur, prompt treatment can make a big difference in the child's health and recovery.

What are the risk factors for paediatric stroke?

Risk Factors for Paediatric Stroke

A paediatric stroke is a stroke that occurs before the age of 18. It can happen to neonates (newborns less than 4 weeks old), infants, children, and adolescents. While paediatric strokes are rare, they can have serious consequences, and it is important to be aware of the risk factors. Here are some of the key risk factors for paediatric stroke:

Congenital Heart Disease

Congenital heart disease is a group of heart conditions that may be present at birth. These conditions can increase the risk of blood clots or cause abnormal blood flow, leading to a stroke.

Cerebral Hypoxia

Cerebral hypoxia refers to a lack of oxygen to the brain during birth. This can happen due to complications during delivery or other factors and increases the risk of stroke in children.

High Blood Pressure (Hypertension)

High blood pressure is a known risk factor for stroke in both adults and children. It can increase the likelihood of blood vessel damage and clot formation, leading to a stroke.

Blood Clotting Disorders

Blood clotting disorders, such as thrombophilia or hemophilia, can increase the risk of blood clots forming in the brain, resulting in a stroke. Sickle cell disease is one such condition that can lead to stroke in children.

Traumatic Brain or Neck Injury

Traumatic brain injury (TBI) or neck injury can damage blood vessels and increase the risk of stroke. This includes injuries that result in low oxygen to the brain.

Genetic Syndromes

Certain genetic syndromes, such as Down syndrome, can increase the risk of stroke in children. These conditions may affect blood vessel development or function, making individuals more susceptible to stroke.

It is important to note that the causes and risk factors for paediatric stroke can vary, and in some cases, the exact cause may not be determined. However, by being aware of these risk factors and seeking prompt medical attention, the impact of paediatric stroke can be minimised, and children can have a better chance of recovery.

What are the symptoms of paediatric stroke?

Symptoms of Paediatric Stroke

Strokes are rare in children, but they can still happen, and it's important to know the signs to look out for. The symptoms of a paediatric stroke will vary depending on the child's age, but here are some general indicators to watch out for:

• Weakness or numbness on one side of the body: This is a common sign of a stroke in children and can cause hemiplegia (paralysis on one side of the body).
• Speech difficulties: Your child may experience aphasia (difficulty speaking or understanding words) or have problems with language more generally.
• Trouble balancing or walking: This could be a sign of clumsiness or ataxia.
• Vision problems: Blurred or double vision, or even loss of vision, could be a symptom of a stroke.
• Sudden lethargy or drowsiness: If your child suddenly becomes very tired or sleepy, this could be a warning sign.
• Seizures: Unusual rhythmic movements of one or both sides of the body can be a symptom of a stroke.
• Headaches: Headaches, possibly accompanied by vomiting, can be a sign of a stroke in older children.
• Behavioural changes: Sudden mood or behavioural changes can be an indicator of a stroke.
• Learning or developmental problems: Delays in reaching developmental milestones, such as rolling over or crawling, can be a symptom of a stroke in infants.
• Paralysis: Sudden paralysis or weakness on one side of the body is a serious sign that requires immediate medical attention.

It's important to note that the symptoms of a paediatric stroke can be subtle and may not always be immediately recognisable as a stroke. If you suspect your child is having a stroke, call emergency services immediately. Prompt treatment can make a significant difference in your child's health and recovery.

How is a paediatric stroke diagnosed?

A paediatric stroke can be challenging to diagnose, as symptoms are not always immediately recognisable. In some cases, a stroke is only discovered to be the cause of seizures or developmental delays after many other conditions have been ruled out.

If a stroke is suspected, a doctor will want the child to undergo one or more of the following tests:

• Magnetic resonance imaging (MRI): a safe and painless test that uses magnets, radio waves, and computer technology to produce images 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 images 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 (spinal tap).
• Catheter angiogram: a thin, flexible tube is inserted into blood vessels, contrast is injected, and X-rays are used to take pictures of the arteries and veins in the brain.
• Echocardiogram (Echo): an ultrasound of the heart.
• Electroencephalogram (EEG): to determine if the patient is experiencing seizures.
• Blood tests: to determine if they have sickle cell disease or conditions that cause blood clots.
• Genetic testing: if certain genetic disorders are the suspected cause of the stroke.

How is a paediatric stroke treated?

The treatment for a paediatric stroke depends on the type of stroke, the symptoms, the area of the brain affected, and the amount of brain tissue damaged. Here is an overview of how paediatric strokes are treated:

Medical Therapy

Children may be given aspirin or other blood thinners (anticoagulants) and special vitamins. Those with sickle cell disease and stroke may be treated with hydroxyurea, transfusion therapy, or both. If the stroke is causing seizures, anti-seizure medication will also be administered.

Interventional Neuroradiology

If the child has abnormal connections in blood vessels that feed the brain (arteriovenous malformation) or blood vessels with weakened walls that can bulge and tear (aneurysm), doctors may place a catheter inside the affected blood vessel to repair the abnormal area. In some cases, a catheter can be used to remove large clots in blood vessels to restore blood flow to the brain.

Surgery

A surgical procedure may be required for certain types of stroke and other cerebrovascular disorders. The type of surgery will depend on the cause of the stroke. Surgery to remove a piece of bone (craniectomy) may be needed in cases with severe brain swelling. Other surgeries for stroke include the closure of abnormal blood vessels, removal of abnormal areas of the brain, and rerouting blood vessels to help provide blood supply to injured areas.

Rehabilitation

Follow-up care is crucial for children who have suffered a stroke. Once the child is stabilised, the medical team will work with them and their family to create an ongoing plan to assess the child's function and optimise recovery. Depending on where in the brain the stroke occurred, the child may experience difficulties with walking, seeing, speaking, or reading. The stroke may also cause a seizure disorder or impact the child's thinking or emotions.

Frequently asked questions