Stroke remains among the top 10 causes of death in children

5:23 AM, Oct 08, 2018

Strokes are one of the leading causes of death in America, claiming one life every four minutes.

And before you think you’re safe because of age, think again. Nearly 25 percent of strokes are occurring in people under the age of 65, according to the CDC.

Even though it seems unthinkable, children can have strokes, too.

A stroke, which blocks blood flow or causes bleeding in the brain, can happen at any age. It’s a myth that only older adults have strokes. Stroke can happen to teenagers, children, newborns, and unborn babies.

“The kids can have delay of learning, they can have residual seizures, or they can have mental impairments due to the strokes. But most of the kids, because the brain is growing,  they tend to do okay,” said Corpus Christi Medical Center Emergency Director Dr. Juan Ramirez.

The risk of stroke in children is 11 in 100,000 per year.  In some cases, the cause is sickle cell disease, immune disorders, or a heart defect.

“We have to address the correct pathology that is causing this. If it is sickle cell disease,  we transfuse these kids. If it is a hereditary coagulation problem, we have to give blood thinners, and most of the time, we have to give antiplatelets like aspirin for life to keep the blood thin” said Ramirez.

Although strokes in kids aren’t common, parents are advised to recognize signs of stroke and know the risk factors for all ages.

“Signs and symptoms on a young kid can present differently from an adult. They can have extreme sleepiness, they have the tendency to only use one side of the body, and as a result, they walk to one side or they fall. Other symptoms can be severe headaches, vomiting, sleepiness, dizziness, and as I mentioned, the loss of balance or coordination,” said Ramirez.

While strokes in children can be devastating, children have a better ability to heal than an adult.

“As a young kid, you have a very high chance to recover completely if you get treatment on time, and also if you get the therapy that you need because the brain of the children are just developing and have a higher chance to recover,” said Ramirez.

The most important thing to remember is to call 911 and get help quickly if you think your child has had a stroke.

Seven signs of stroke in infants and children

You know your child best. And with stroke, time is of the essence. You can help by telling doctors what unusual

symptoms you are noticing.

Watch out for these signs of stroke in children:

  1. Severe and sudden headache with vomiting and drowsiness
  1. Vision loss or double vision
  1. Severe, intractable dizziness
  1. Loss of balance or coordination
  1. Seizures on one side of the body
  1. Numbness or weakness on one side of the body
  1. Difficulty speaking or understanding others

In very young children, it is easy to misunderstand or miss the signs of a stroke. As stroke isn’t common in babies, kids or adolescents, doctors may attribute symptoms to a more common ailment.

How to remember signs of stroke:

One way to remember the signs is to know the acronym — BE FAST:

Balance – Sudden loss of coordination, balance, trouble with walking or dizziness

Eyes – Sudden change or loss in vision (double vision, blurry vision or the feeling of a shade coming down over the eye)

Face – Sudden weakness or asymmetry of the face

Arms – Sudden weakness or numbness of the arm and/or leg

Speech – Sudden difficulty producing speech or language (trouble finding words or understanding spoken and/or written commands)

Time – Time to call 911 and note the time symptoms started.

Pediatric Stroke:

The risk of stroke in children is greatest in the first year of life and during the period of right before birth to right after birth. Stroke remains among the top 10 causes of death in children.

Stroke is relatively rare in children, but can lead to significant morbidity and mortality.

Understanding that children with strokes present differently than adults and often present with unique risk factors will optimize outcomes in children.

Stroke is a neurological injury caused by the occlusion or rupture of cerebral blood vessels. Stroke can be ischemic, hemorrhagic, or both. Ischemic stroke is more frequently caused by arterial occlusion, but it may also be caused by venous occlusion of cerebral veins or sinuses.

Hemorrhagic stroke is the result of bleeding from a ruptured cerebral artery or from bleeding into the site of an acute ischemic stroke (AIS).

AIS accounts for about half of all strokes in children, in contrast to adults in whom 80–85% of all strokes are ischemic.

Unique Symptoms:

Because people do not think about newborns and children having strokes, they are not often recognized or treated properly.

Another challenge with newborns is that they cannot communicate symptoms that are not readily visible.

The common stroke warning signs—FAST—used to identify stroke in adults can also be used to identify strokes in children.  But, there are some specific symptoms that you should look for in children depending on their age.

In newborns and infants

  • Seizures
  • Extreme sleepiness.
  • Tendency to use only one side of their body.

In children and teens

  • Severe headaches
  • Vomiting
  • Sleepiness
  • Dizziness
  • Loss of balance or coordination

Common Risk Factors:

Stroke happens in about 1 in 4,000 live births. The risk of stroke from birth through age 18 is almost 11 in 100,000 children per year. Strokes are slightly more common in children under age 2.

Boys and African-American children are at a higher risk for stroke than other groups.

While high blood pressure, an irregular heartbeat and a hardening of the arteries are common causes of adult strokes, they are rare in children. Common risk factors for stroke in children include:

  • Congenital heart defects
  • Sickle-cell disease
  • Immune disorders
  • Diseases of the arteries
  • Abnormal blood clotting
  • Head or neck trauma
  • Maternal history of infertility
  • Maternal infection in the fluid surrounding an unborn baby
  • Premature rupture of membrane during pregnancy
  • Pregnancy related high blood pressure in the mother

Treatment:

Children usually recover better from strokes than adults do because their brains are still growing. However, children can experience permanent complications from stroke, such as seizures, weakness, and vision problems.

Treatment for pediatric stroke depends on the specific cause. Some common treatments used with adults are not appropriate for young children and infants.

One of the best treatments for ischemic strokes for adults is tPA, or tissue plasminogen activator, a drug that dissolves blood clots.

With children under 18, use of tPA is controversial and currently limited to clinical trials. Further studies on safety and benefits of this treatment are necessary.

Rehabilitation methods with pediatric stroke survivors are also not clear and require further clinical trials.

Current treatments for pediatric stroke include:

  • Supportive care to maintain normal body temperature, proper hydration, and normal blood sugar levels.
  • Controlling high blood pressure.
  • Detecting and treating seizures with EEG monitoring and anticonvulsant medication.
  • Managing intracranial pressure.
  • Blood transfusions for children with sickle-cell disease.
  • Antithrombotic therapy, which refers to medications used to prevent blood clots from forming or growing, is used in children but generally not infants.
  • Surgery related to hemorrhagic stroke (and less commonly, ischemic stroke) is sometimes performed to relieve pressure on the brain.

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