Can a Child have a Stroke? NP Kathleen Andres has the answers here in the October “Ask the NP” Edition
Question: Can Children have Strokes?
Strokes can occur at any age, from before birth into young adulthood. Between 3 and 6 per 100,000 children aged 28 days to 18 years are affected by stroke. This rate is even higher among newborns, affecting 1 in 2,300 live births each year. Stroke can be broadly categorized as bleeds in the brain (hemorrhagic strokes) or localized brain injuries caused by impaired circulation through the brain’s blood vessels (ischemic strokes).The causes for ischemic stroke in childhood are diverse, but are most commonly related to blood clots.
Arterial ischemic stroke (AIS) occurs when a blood clot interrupts the flow of blood through an artery to an area of the brain. This prevents oxygen and nutrients from reaching the brain tissue in that area and results in a focal region of irreversible brain injury. The location and shape of the injury reflect which artery was blocked.
Cerebral sinovenous thrombosis (CSVT) refers to a blood clot in the system of veins that drain blood away from the brain. Like a clogged sink, the clot may cause blood to back up into the brain and lead to localized swelling of the brain tissue. If left untreated, the brain swelling may progress to cause permanent brain injury and/or bleeding into the brain.
How would I know if a child were having a stroke?
A child may present with similar symptoms to an adult having a stroke, such as severe sudden headache, sudden unilateral weakness or numbness, difficulty speaking or being understood by others, abrupt vision loss or double vision, or severe dizziness or loss of coordination.
Since the brains of newborns and young children are not fully developed, they may also initially present with less specific signs such as a change in their level of consciousness or seizure. In a newborn, seizures may be difficult to identify but are often characterized by repetitive twitching of the face, arm, or leg or apneas associated with staring. An early hand preference (under 1 year of age) may also be a sign that a child had an unrecognized stroke in the past.
What do I do if I think a child is having a stroke?
Call 911! While strokes cannot be reversed, emergency medical attention can help to avoid worsening of the brain injury and prevent stroke recurrence. When possible, transfer to a facility with healthcare providers experienced with childhood stroke is optimal. Stroke continues to be under recognized in children since it is not always the first diagnosis that is thought of to explain the set of symptoms in a child. Raising childhood stroke awareness is the first step in preventing delays in diagnosis and treatment.
The following are excellent resources to refer to if you, or anyone you know, have questions about stroke in children:
- www.aboutkidshealth.ca (by searching ‘stroke’)
Kathleen Andres, RN(EC), MN, NP-Paediatrics
Kathleen is the Nurse Practitioner with the Children’s Stroke Program at the Hospital for Sick Children in Toronto.