Stroke Health Article

Causes

The cause of childhood stroke is unknown in one-third of cases, and an underlying medical condition or multiple conditions appear to contribute to over half of the cases. The most common causes of stroke are congenital (present at birth) and acquired heart diseases, and sickle cell anemia.

About 10–15 percent of children with sickle cell disease suffer a stroke, usually ischemic stroke. Sickle cell disease is a blood disorder in which the blood cells cannot carry oxygen to the brain because the blood vessels to the brain are either narrowed or closed.

One rare cause of stroke is an extreme case of the chickenpox virus, which causes a narrowing of blood vessels in the head for some children.

RISK FACTORS Although obesity, high cholesterol, high blood pressure, atherosclerosis, and smoking are common stroke risk factors in adults, they rarely contribute to stroke risk in children. Risk factors for childhood stroke include a family history of stroke, cardiovascular disease or diabetes, as well as the presence of the conditions listed below.

Some of the more common congenital heart diseases that increase the risk of childhood stroke include:

• aortic and mitral valve stenosis
• atrial septal defect
• patent ductus arteriosus (PDA)
• patent foramen ovale
• inherited blood clotting disorders
• ventricular septal defect
• hypercoagulable states

Some of the acquired heart conditions that increase the risk of childhood stroke include:

• bacterial meningitis
• endocarditis
• arrhythmia and atrial fibrillation
• artificial heart valve
• myocarditis
• cardiomyopathy
• rheumatic heart disease
• embolism
• anoxia
• antiphospholipid antibody syndrome
• encephalitis
• blood vessel disease
• certain blood disorders, such as hemophilia
• inborn errors of metabolism
• illicit drug use
• teenage pregnancy
• teen use of oral contraceptives (birth control pills)

Possible traumas that increase the risk of childhood stroke include birth injury or trauma, child abuse, or other injury or trauma.

Because of the wide range of secondary conditions that contribute to stroke, it is difficult for researchers to assess the relative contribution of each risk factor to the problem of cerebrovascular disease as a whole, according to the Child Neurology Society Ad Hoc Committee on Stroke in Children. In addition, this variability also hinders clinical research.

Symptoms

In infants and very young children, stroke symptoms are sudden and include:

• seizures
• coma
• paralysis on one side of the body
• nausea or vomiting

In older children, stroke symptoms are sudden and include:

• numbness or weakness of the face, arm, or leg, especially on one side of the body
• confusion or difficulty speaking or understanding speech
• vision difficulties, often in one eye
• hearing problems, often in one ear
• difficulty walking, dizziness or loss of balance or coordination
• severe headache
• difficulty swallowing
• nausea or vomiting
• painful or stiff neck

Other stroke signs and symptoms include:

• sudden severe headache with unknown cause
• sudden nausea or vomiting
• warm, flushed, clammy skin
• slow, full pulse
• appearance of unequal pupils
• facial "droop" on one side
• salivary drool
• urinary incontinence

If the child seems to recover quickly from these stroke symptoms, a TIA may have occurred. All neurological symptoms should serve as a stroke "warning sign" and could indicate a pending, more serious attack. The child should receive prompt evaluation so necessary preventive therapies can be initiated.

WHEN TO CALL THE DOCTOR If a child has any of the symptoms listed above, the parent or caregiver should immediately dial 9-1-1 to seek emergency care. It is important not to wait to see if symptoms subside; a stroke is a medical emergency. Until the paramedics arrive, the parent or caregiver should follow these first aid guidelines:

• Make sure the child is in a comfortable posture, lying on his or her side, so the airway does not become obstructed by drool or mucus.
• Talk reassuringly to the child, even if he or she is unconscious.
• Do not leave the child alone—constantly observe the child.
• Cover the child with a blanket or remove clothing as needed to maintain the child's normal body temperature.
• Do not give the child any medication, including aspirin; medication will be given later as needed.