Strokes Can Also Occur in Children

Jared’s mother Victoria saw her son sit down and hold his head while playing at St. Catherine’s Park in New York City.  She ran over to him and he told her his head hurt.  As Jared stood up, he began to stumble and it was apparent that his left leg wasn’t working well.  His speech began to slur and then his eyes rolled up in his head.  Victoria panicked and scooped Jared up and ran the single block to Weil/Cornell Medical Center all the while telling Jared, “Stay awake, baby, just stay awake.”

According to the Pediatric Stroke Program at Children’s Hospital of Philadelphia, “strokes are the sixth leading cause of death in children, affect 25 in 100,000 newborns and 12 in 100,000 children under 18 years of age”.  We typically think that strokes just    happen to adults so often delays in accurate diagnosis occur when symptoms appear in children.  On average, adults are diagnosed with a stroke within 12 to 24 hours while it may take as long as 48 to 72 hours to diagnose a child.

In infants the most common symptoms of stroke are seizures, extreme sleepiness and using only one side of the body.  In children and teens, classic symptoms of one sided weakness, difficulty in speech, severe headache or trouble seeing with one or both eyes might be mistaken for new onset seizures, poison or drug ingestion, migraines or even a severe virus.

Newborns who suffer a stroke in utero may be born with cerebral palsy. In other children, symptoms of a stroke do not show up until a couple of years later while they are learning to walk or talk.  A stroke can occur if blood clots in the placenta block blood flow to the fetus or malformed blood vessels may contribute to clot development in the brain.  Maternal high blood pressure or pelvic inflammatory disease has been shown to increase to the risk of stroke in the developing newborn.

Children with sickle cell disease, congenital heart defects or other clotting disorders are at risk of having a stroke.  According to medicine.net, 10% of children with sickle cell disease have a stroke before the age of 21.  A Transcranial Doppler Ultrasound (TCD) test has been recommended by the Academy of Neurology to be used on sickle cell children for screening. It was determined if those children at risk received blood transfusions, it would lower their risk by 90%.  Unfortunately, there are a limited number of labs who are able to perform this test even when children have adequate health insurance coverage.

Main types of strokes and who is at risk:

1.  Arterial Ischemic Stroke (AIS): This can occur from a blood clot that forms in the heart and travels to the brain and blocks the blood and oxygen supply.  Children with congenital heart defects, sickle cell disease, certain immune diseases or those who have suffered a neck injury are at risk for this type of stroke.  Blood clots cause half of all childhood strokes.

2.  Hemorrhagic Stroke: This can occur from weakened blood vessels in the brain that rupture.  This can occur in children with AV (arterio-venous) malformations or those who have certain diseases such as hemophilia.

Diagnosis of a stroke is made after performing either a MRI or MRA brain scan as well as from additional information from the medical history, lab work, coagulation studies, EKG, lumbar puncture, Transcranial Doppler ultrasound (TCD) and cervical spine x-rays.

Treatment for strokes in children:

Currently, treatment guidelines in children only include: transfusions for sickle cell patients and replacement of clotting factors for those who are deficient.  TPA (Tissue plasminogen activator) is only approved for adults due to risk of bleeding though the American Heart Association has identified that further investigation needs to be done for its use in children.  Post stroke treatment in children is aimed at rehabilitating areas affected and may be required for years to regain losses.    

Nurses have a role in the prevention and early assessment of strokes in newborns and children.  Maternal health promotion is the first step to pediatric stroke prevention through blood pressure screenings, adequate prenatal care and early treatment of gynecologic infections. Knowing that sickle cell children are especially risk should alert nurses to any signs or symptoms of a stroke in these children.  There is a quick assessment pneumonic to help identify any child who may be having a stroke from www.stroke.org called “FAST”.

●  Face: Ask the child to smile, does one side of their face droop?

●  Arms: Ask the child to raise both arms, does one  drift downward?

●  Speech: Ask the child to repeat a sentence, do their word slur?

●  Time: If the answers above are yes, call 911 immediately.  Brain cells are dying.

Sources:

Dienst, J. 2010 January, 18. Children Don’t Have Strokes? Just Ask Jared. New York Times accessed at www.nytimes.com/2010/01/19/health/19stroke.html?ref=health

www.medicinenet.com/script/main/art.asp?articlekey=99298

www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm#140333104

www.pediatricstroke.org/index.html

www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm#140323104

Handouts for parents on strokes in kids:

http://www.americanheart.org/downloadable/heart/1246466787464FACTS%20-%20Stroke%20in%20Infants%20and%20Children.pdf

www.chop.edu/export/download/pdfs/professional/physician-referral/saving-young-minds.pdf

Michele Blacksberg is an R.N. freelance writer and has been a nurse for almost 30 years.