Strokes in Children Not the Same as in Adults
For the first time ever, the American Heart Association and the American Stroke Association have issued guidelines for dealing with strokes in infants and children, an event once thought so rare that such guidelines were not warranted. New diagnostic tools and in-depth studies of the children who experience strokes, however, reveal the event is still uncommon but not so rare that similarities and specific characteristics cannot be documented. And one very important factor in children’s strokes is that they are quite different from the strokes adults suffer; so different, in fact, that treatment and prevention measures are most effective when handled in an age-appropriate manner.
As recently as 20 years ago, strokes were considered so unlikely in children that they were rarely diagnosed. With today’s improved diagnostic tools, including vascular ultrasound and magnetic resonance imaging (MRI), evidence reveals the risk of a child having a stroke before his or her 19th birthday is 10.7 for every 100,000 children every year.
Often the first symptom of stroke in a newborn is seizure, usually involving just one arm or leg. Seizures are such a common symptom of stroke in newborn babies, even full-term babies, that about 10% of all seizures are now attributed to strokes. Experts today consider strokes immediately before or immediately after birth to be a leading cause of cerebral palsy. Although not unheard of, seizures are rarely associated with strokes in adulthood.
When children have strokes, one or more risk factors is known before the event in more than 50% of cases. In other cases, risk factors are discovered during thorough evaluation after the event. The first year of life is the most risky for childhood strokes, with the first two months considered the most critical. The risk of neonatal strokes, those occurring during the first month after birth, has been established at one for every 4,000 live births. A child’s risk of having a stroke generally diminishes with age.
Just like strokes in adults, however, it is equally as important to diagnose and treat strokes in children of all ages as quickly as possible to minimize any brain damage or risk of death or disability that might be caused by the event. Recommended treatment and rehabilitation therapies differ with age, though.
When treating adult stroke patients, a drug called tissue plasminogen activator (t-PA) is almost always used when the stroke is ischemic, or caused by a clot in the brain. In the Western world, about 80% to 85% of all adult strokes are ischemic and t-PA is a powerful clot-busting agent. Strokes in children are ischemic only about 55% of the time, with the remaining 45% of them hemorrhagic, or caused by bleeding in the brain, a situation for which t-PA is ineffective.
Atherosclerosis, a build-up of fats, cholesterol, and other substances along the lining of the arteries that are generally referred to as plaque, is the main cause of strokes in adults but children and infants rarely develop this condition. Instead, strokes in children are caused by a number of risk factors, with sickle cell disease and heart disease, both congenital and acquired, being the most common causes. Other risk factors include:
- Dehydration
- Infection in the head and neck
- Trauma to the head
- Systemic issues such as disorders to the autoimmune system and inflammatory bowel disease.
Infants are also at risk of stroke due to situations that affect their mothers and their pregnancies, such as:
- A woman’s history of infertility
- Infection of the fluid surrounding a developing fetus, a condition called chorioamnionitis
- Membranes rupturing prematurely
- High blood pressure related to pregnancy, called preeclampsia
Other conditions that cause strokes in adults but not children are cigarette smoking, diabetes, atrial fibrillation, hypertension, artery disease, and being 55 or older.
The one risk factor shared by both adults and children of all ages is sickle cell disease.
To prevent adult strokes, patients are urged to change behaviors or medications known to increase the risk of stroke. Risk factors are not always known in infants and children, with the stroke itself often being the first sign of illness, so prevention measures most often involve preventing a second, or subsequent, stroke. In children, treatment of the underlying cause is considered the most effective preventive measure.
Once a child has had a stroke, measures recommended to prevent future strokes include:
- Treating migraine headaches, since migraines in children, especially those with aura, are thought to increase the child’s risk of ischemic stroke
- Stroke-prevention education that stresses the importance of a lifestyle based on a healthy diet and ample exercise, as well as the avoidance of all tobacco-related products
- Alternatives to oral contraceptives for girls who’ve had strokes or have been treated for cerebral venous sinus thrombosis (CVST)
- Thorough evaluation of all possible risk factors when trauma to the head has occurred
Since the just-released guidelines are the first of their kind, the writing committee urges continued research into the diagnosis, risk factors, and treatment of childhood strokes, with updates to be issued as more information is gathered and improved technologies are developed.
Source: American Heart Association
Thank you… Thank you I loved reading your article!!!
My son Blake had a stroke last year at the age of 15. Leaving him totally paralyzed on the right hand side of his body.
After intense rehab in hospital he has recovered rather well, he is attending school part time, and starting to sail again. We still have no cause on why Blake initially had the stroke?
I would like to mention that he was one of the first children to receive the injection to disolve the clot immediately, which is only used in adults. I am so pleased they offered us that option!!
Regards to you
Karee ~ Ann
My grandson suffered multiple strokes this summer. He was healthy beforehand; the strokes occurred after he was hospitalized for the onset of junvenile diabetes. The cause for the strokes was not determined.
He is now in a long-term faciltiy for children. I was wondering what was involved with the ‘intense rehab’.
In searching for additional information on Strokes in Children, I came across this article, to which I found so true. Our 13 year old daughter suffered a stroke last April during Phy Ed at school. Ironically, her 78 year old grandmother had a stroke 4 months earlier on Dec. 26, 2008. We understand this article very much! Like Karee ~ Ann’s son, Blake (comment above), we have no cause as to why this happened. All her tests came back inconclusive to give a definite answer. She too received the adult drug, t-PA, to which we are so thankful. She was one of the first kids at Rady’s Children’s Hospital, here in San Diego to have been administered this “clot buster”. She has returned to school this fall with 5 periods and no Phy Ed in her schedule due to being on the anti-coagulant, Lovenox. She continues with slight weakness in her left foot and left hand, as the stroke for her happened on the right side of her brain leaving her with the left side affected. What we have noticed the most is the mental piece that no one sees. The part of the brain that was damaged due to the stroke. It would be so great to have other families to connect with who have experienced stroke with a child since it is so rare and who are looking to compare notes so to speak.
Blake, may you have continued improvement and return to full capacity.
hi – my 3 year old son has been suffering from “episodes” resembling strokes. They occur 9 times out of 10 when waking up from sleep (nap or middle night). His arm goes stiff and he slurs, crooks his rightside eye and mouth and sort of falls down like trying to smell something. Not trying to jump gung here but we did do MRI for possible stroke – like symptoms. I am so unclear as to how happens in toddlers. Are strokes specific to times of day? Any feedback most appreciated
thanks!
hi,
I’ve been searching internet to find out anything about strokes in children.
My son just turned eight. Four weeks ago we were out of town in a hotel. He was sleeping with me and I heard him making a strange noise. When I turned on the light he appeared to be having a seizure. His eyes were rolled slightly back to the right, he was gasping for air and making that horrible (what I call death rattle sound), his mouth seemed twisted and he was convulsing. I should point out he has NEVER had a seizure or anything remotely like one before. I feaked out and called 911. The episode lasted about 8-10 minutes. When he came out of it he couldn’t breath well so they gave him oxygen and did a chest x-ray etc.
I took him to our hometown hospital that night and they gave him a CAT scan. This came back pretty normal. I took him to a pediatric neurologist two weeks later when we could finally get an appointment and his EEG came back normal, but his MRI showed he had some bleeding on the left side of his brain ( the doctor said it appeared to be a light stroke which in turn must have triggered the seizure earlier. ) He hasn’t had another seizure since and he doesn’t appear to have been affected by the stroke as far as speech, paralysis etc. The ped. nuerologist has scheduled a MRA for early Dec. and and EKG and heart monitor to check for blood vessal and cardiac problems which could be the cause. Right now he seems fine other than complaining of stomach cramps very frequently and chest pain once in a while /and or difficulty breathing (though he is NOT wheezing) He is extremely pale, doesn’t eat well and has dark circles under his eyes which makes him look sickly. But, physically he is fairly active and seems ok. This is a very scarey time for us and I’m not sure what to think. I would have NEVER dreamed the MRI would have shown a stroke in my eight year old child. But, after reading up on it, I can see it is not as uncommon in childrn as I thought. I’m just worried about what the tests will show now. I should also mention he had mono about 6 weeks ago. I’m not sure if any of this could be a complication from that or not.
My Daughter has her first stroke(s) at 14 months. Walking and running normal and laughting one day we whento the beach.
She just sat down and stopped walking.
We couldn’t get her to walk again and the doctor (Kaiser) first appointment said she has strep throaght, hours later doing worse we took her back and another one said she had an ear infection.
A few more hours later getting even worse we took her back again and they called the ambulance and rushed her to Inova Fairfax Hospital.
My wife freaking out they said she had a low blood H&H level.
After hours through the night and into the next day with the infectious decease and neurologist arguing over what it was they started pumping her with prednizone.
Weeks later we said stop as it was just making her FAT unless they could show/prove results. She had literally went from 16 to 30Lbs in 26 days.
After a little over 10 months in the hospital we went home.
We just started over teaching walking etc…
She got better as the doctor said she is young and will learn again.
5 years later it happened again.
She started yelling her feet hurt and were stinging.
We went to the doctor and he couldn’t see anything.
We went again and suggested and MRI he said it did not warrant adn MRI.
Finally we wnet and again 2 more strokes.
now at 11 another one this time kinda bad, slurred speach, left arm responding slow and ability to walk not that great.
My 11 Year old granddaughter had a stroke on Dec. 3, 2009. She was at school jump rope. She has never been sick. She lost all feeling on her right side,lost speech. We were told it happened because of a simple virus. I don’t really understand! Can it happen again? Happy to say she is walking & talking again. Shes not back to school full time yet.
My daughter had a stroke when she was born on March 31,2003. Her stroke was caused by a blood vessel bursting during the birth. Several hours after birth,she started having seizures that just looked like her eyes twitching. Fortunately, we caught hers early and she was treated very quickly. She is fixen to turn 7 and is doing great. She has not had any problems since she was released from the hospital. She is a very smart girl, anyone that meets her cannot believe she has had a stroke.
MY GRANDSON IS 14 MONTHS OLD AND HAS JUST BEEN CONFIRMED TO HAVE HAD A STROKE POSSIBLY INUTERINE. WE BEGAN TO NOTICE HE ONLY USED THE LEFT HAND AND IT TOOK A WHILE FOR HIM TO SIT UP OR CRAWL…IN FACT HIS CRAWL WAS A SCOOT WITH THE RIGHT LEG DRAGGING BEHIND STANDING ALONE AND WALKING HAS HAPPENED BUT HE FALLS A LOT, RIGHT FOOT IS TIPTOED AND HE TENDS TO GO TO THE LEFT WHEN HE WALKS. HE IS ADVANCED IN OTHER AREAS OF SKILLS AND HAS ADAPTED TO THIS STYLE OF MOVEMENT. IT TOOK 10 MONTHS TO GET A DR TO ORDER THERAPY FOR HIM AND THEN A NEUROLOGIST. HE IS DOING SO SO IN THERAPY DUE TO TEMPERMENT. AN EEG SHOWED NO SEIZURE ACTIVITY. THE MRI JUST CAME BACK AND NOW WE HAVE TO GET WITH THE NEUROLOGIST TO DECIDE WHAT TO DO FROM HERE. WE HAVE BEEN TOLD IT WAS A STROKE AND THAT IS ALL SO FAR. OUR CONCERNS NOW IS WHAT DRS ARE BEST WITH THESE CASES AND WHAT THERAPY WORKS BEST FOR HIS AGE. THE ONLY FACTOR WE CAN FIND IS THE FACT THAT MOM HAD A DIFFICULT PREGNANCY WITH LOW AMBIOTIC FLUID AND AFTER BIRTH WE HAD HER RIGHT BACK IN THE HOSPITAL WITH A 3CM INFECTION POCKET IN THE UTERUS. THIS WAS FOUND WITH THE SAME SYMPTOMS SHE COMPLAINED THE WHOLE PREGNANCY TO HER DR THAT C0NTINUED TO GIVE HER PAIN MEDS INSTEAD OF INVESTIGATING THE SITUATION AND EVEN STARTED TO DO THE SAME IN THE ER AFTER THE BIRTH WHEN HER TEMP WAS 107. ABOUT 6 MONTHS INTO THE PREGNANCY SHE HAD A VERY ELEVATED BP FOR A COUPLE DAYS THAT WAS ALSO PUSHED TO THE SIDE BY HER DR. SO MANY QUESTIONS TO ASK AND DO NOT KNOW WHERE TO BEGIN.
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My daughter had inutero stroke did not confirm until around 11mos old. Did therapy was ok until age of 3 she had a nap and woke up and was unable to stand or walk. We immediately knew something was wrong had all kinds of test vanderbilt childrens hospital could not find anything knew the only thing they could tell us is that there was no change according to her previous mri records. We learned to walk again started all of her therapy back and within maybe six months she was able to walk again. Then the worst …Seizures. Out of the blue she had several life changing seziures in Nov of 2008. She fought very hard and made it through. She is now medicated on lyrica she takes 100mg twice daily and we really would like to take her off of meds but are still praying and trying to make best decision. She is a happy, 6 year old now. She is very very bright makes 100s on all of her tests at school is in girl scouts (daisy) and she truely is our little angel from heaven. She does have a slight limp and she does’nt use her right hand as much as we wish but she is very loved by her brothers and mommy and daddy.