Stroke Recovery: Having Children Post-Stroke

A stroke is a life-threatening condition that occurs when blood flow to the brain is interrupted, either by a blocked blood vessel or bleeding in the brain. While strokes are more common in adults, they can also happen to children and adolescents. The risk of stroke is highest before the age of one, and it is one of the top 10 causes of death in children. Perinatal strokes, which occur before birth or shortly after, are usually caused by complications during pregnancy or birth, while childhood strokes can be caused by problems with the brain's blood vessels, infections, or autoimmune disorders. After a stroke, children often need therapy to support their development and recovery, and early intervention is crucial for minimizing brain injury and the risk of another stroke.

What are the risk factors for a stroke in children?

While strokes are much more common in adults than children, they can still occur in children of all ages, even those who haven't been born yet. The risk of stroke is highest before the age of one, and it is one of the top 10 causes of death in children.

Heart Problems

Heart problems are the most common risk factor for stroke in children. Congenital heart disease, a group of heart conditions that may be present at birth, can increase the risk of blood clots or brain bleeds. Heart defects that a baby is born with can also cause ischemic strokes, which are the most common type of stroke in children.

Sickle Cell Disease

Sickle cell disease is a blood disorder that can increase the risk of blood clots or brain bleeds. It is a common cause of stroke in children and can be treated with hydroxyurea, transfusion therapy, or both.

Infections

Infections such as meningitis or chickenpox can increase the risk of stroke in children. Encephalitis is another infection that can lead to stroke.

Blood Clotting Disorders

Blood clotting disorders, such as thrombophilia or hemophilia, can increase the risk of ischemic stroke in children. These disorders can cause blood clots to form, blocking blood flow to the brain.

Blood Vessel Abnormalities

Blood vessel abnormalities, such as arteriovenous malformation (AVM), can increase the risk of bleeding in the brain. AVM is a condition in which the blood vessels in the brain don't connect properly. Children may be born with these malformations, increasing their risk of stroke.

Traumatic Brain or Neck Injury

Traumatic brain injury (TBI) or neck injury can increase the risk of stroke in children. This can include injuries that result from low oxygen to the brain.

Genetic Syndromes

Certain genetic syndromes, such as Down syndrome or Moyamoya disease, can increase the risk of stroke in children. Moyamoya is a rare disease that affects the arteries in the brain.

Conditions During Pregnancy

Some conditions during pregnancy can increase the risk of pediatric stroke, including gestational diabetes, premature rupture of membranes, and placenta problems that decrease the baby's oxygen supply.

What are the signs of a stroke in children?

Strokes are rare in children but can occur at any age, from babies in the womb to older children and adolescents. They are a life-threatening condition that requires immediate medical attention.

Strokes in children often occur within the first month after birth, known as perinatal or neonatal strokes. These strokes happen during or after delivery when the baby doesn't receive enough oxygen in the birth canal.

Older children may also experience strokes, though these are usually caused by another condition that affects blood flow to the brain or causes bleeding in the brain.

Signs of a stroke in infants include:

• Seizures in one area of the body, such as an arm or leg
• Trouble breathing or pauses in breathing (apnea)
• Early preference for using one hand over the other
• Developmental delays, such as rolling over and crawling later than usual

A seizure may be the first sign of a stroke in older children and adolescents. Other signs include:

• Sudden paralysis or weakness on one side of the body
• Language or speech delays or changes, such as slurring
• Vision problems, such as blurred or double vision
• Tendency not to use one of the arms or hands
• Tightness or restricted movement in the arms and legs
• Trouble with schoolwork
• Sudden mood or behavioural changes
• Headaches, possibly with vomiting
• Neck pain or stiffness
• Numbness or tingling
• Onset of lethargy or difficulty walking
• Sudden loss of consciousness

If you suspect your child is having a stroke, call 911 immediately. Getting prompt treatment can significantly impact your child's health and recovery.

How is a stroke diagnosed in children?

Although strokes are more common in adults, they can also happen to children. In fact, strokes can occur at any age, from babies in the womb to older children and adolescents.

Strokes in children can be challenging to diagnose, as symptoms are often not immediately recognisable. In some cases, a stroke is only discovered when a child experiences seizures or developmental delays, and other conditions have been ruled out.

If a stroke is suspected, a doctor will want to run some tests, including:

• 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).
• CT angiogram: to check how blood flows through the heart, blood vessels and brain.
• Brain MRI: to visualise the structure of the brain and blood vessels.
• Echocardiogram (Echo): to check the heart structure.
• Electroencephalogram (EEG): to determine if seizures are occurring.
• Blood tests: to determine if the child has sickle cell disease or conditions that cause blood clots.
• Genetic testing: if certain genetic disorders are suspected as the cause of the stroke.

How is a stroke treated?

The treatment for a stroke depends on the type of stroke, the symptoms, the area of the brain affected, the amount of brain tissue damaged, and whether an ongoing condition caused the stroke.

In the first 24 hours after a stroke, treatment may include medicine to get rid of blood clots in the brain (thrombolysis), surgery to remove a blood clot (thrombectomy) or drain fluid from the brain, or a procedure to stop pressure from building up inside the skull or brain.

Medicines used to treat strokes include anticoagulants to stop blood clots from forming, medicines to lower blood pressure, and statins to lower cholesterol.

Physical medicine and rehabilitation, or physiatry, are also important parts of stroke treatment. Physiatrists are doctors who use different types of therapy to help children recover from a stroke. They work to enhance and restore functional ability and quality of life.

For ischemic strokes, providers often use thrombolytics (or possibly a procedure called thrombectomy) to restore blood flow to the brain. Tissue plasminogen activator (tPA) is a thrombolytic that improves the chances of recovering from a stroke.

Hemorrhagic strokes may be treated with surgery. If the bleeding is caused by a ruptured aneurysm, a metal clip may be put in place to stop the blood loss.

Endovascular procedures can help repair a weak spot or break in a blood vessel and may be used to treat certain hemorrhagic strokes.

What are the effects of a stroke on a child?

While strokes are rare in children, they can still occur and have serious consequences. A stroke is a life-threatening condition that occurs when blood flow to the brain is interrupted, either by a blockage or a rupture in the blood vessels. This interruption causes brain cells to die, leading to a loss of brain function. The effects of a stroke on a child depend on the area of the brain affected and the extent of the damage.

Physical Effects

Children who have experienced a stroke may suffer from weakness or paralysis on one side of the body, known as hemiparesis or hemiplegia, respectively. This is due to the left and right sides of the brain controlling different physical and cognitive functions. For example, the left side of the brain controls reading, talking, thinking, and mathematics, while the right side controls skills such as buttoning a shirt and memory. As a result, a stroke on one side of the brain can lead to specific physical and cognitive deficits.

Children may also experience vision problems, such as blurred or double vision, and difficulties with balance and coordination. In some cases, they may have trouble swallowing (dysphagia). The physical effects of a stroke can be immediate, and early rehabilitation is crucial for maximizing recovery.

Cognitive and Behavioral Effects

Strokes can also impact a child's cognition and behavior. Children may experience communication problems, including difficulties with speech and language (aphasia). They may also have problems with memory, judgment, and problem-solving abilities (cognitive changes). Behavioral and personality changes are also common, and children may exhibit loss of emotional control and mood changes.

Additionally, children who have had a stroke are at a greater risk for developing epilepsy and may experience seizures. These seizures can vary in severity, ranging from staring spells to violent shaking of a limb.

Long-Term Effects

The long-term effects of a stroke on a child can vary depending on the age of the child and the timing of the stroke. For example, perinatal strokes, which occur during the prenatal phase or within the first 28 days of life, may not show signs until months or years later. These children may develop more slowly than their peers or exhibit a preference for using one hand over the other.

Overall, a child's growing brain has a better chance of recovering from a stroke than an adult's brain. Early diagnosis, treatment, and rehabilitation are crucial for maximizing recovery and minimizing the risk of long-term problems. However, it's important to note that while most children who have had strokes can interact normally and be active members of their communities, some may still experience lasting deficits.

Frequently asked questions