Stroke Health Article

Surgery

The need for surgical treatment for pediatric stroke will depend on a number of factors, including the type of stroke, extent of damage from stroke, the child's age, and potential benefits and risks. Sometimes urgent surgery is necessary soon after the child is admitted to the emergency room to remove a blood clot and restore oxygen flow to the brain tissue.

Treatment options for hemorrhagic stroke may include surgery, sterotactic radiotherapy, or interventional neuroradiology to treat the underlying aneurysm or arteriovenous malformation.

There are several surgical procedures to repair an aneurysm that may have caused a hemorrhagic stroke. A clip may be placed across the neck of the aneurysm (like a clip at the end of a balloon) to stop the bleeding. A newer approach is to thread a long, thin tube through the artery that leads to the aneurysm. Then a tiny coil is fed through the tube into the aneurysm "balloon" to fill the space and seal off the bleeding.

An interventional procedure called carotid angioplasty may be performed to treat a blockage or blockages in the carotid arteries. During the procedure, a tiny balloon at the end of a long, thin tube (called a catheter) is pushed through the artery to the blockage. When the balloon is inflated, it opens the artery. In addition, a mesh tube (called a stent) may be placed inside the artery to help hold it open.

Carotid endarterectomy is a surgical procedure performed to remove a blockage from the carotid artery. During the operation, the surgeon scrapes away plaque from the wall of the artery so blood can flow freely through the artery to the brain.

Intracranial bypass surgery is a surgical procedure performed to restore blood flow around a blocked blood vessel in the brain. During the surgery, a healthy blood vessel, on the outside of the scalp, is re-routed to the part of the brain that is not getting enough blood flow. This new blood vessel bypasses the blocked vessel and provides an additional blood supply to areas of the brain that were deprived of blood. When blood flow is restored, the brain works normally, and the symptoms disappear. This procedure is not as common as the other surgical treatments listed above to treat pediatric stroke but it may be used to treat recurrent TIAs.

Alternative treatment

Alternative and complementary therapies include approaches that are considered to be outside the mainstream of traditional health care.

Techniques that induce relaxation and reduce stress, such as yoga, Tai Chi, meditation, guided imagery, and relaxation training, may be helpful in controlling blood pressure. Acupuncture and biofeedback training also may help induce relaxation. Before learning or practicing any particular technique, it is important for the parent/caregiver and child to learn about the therapy, its safety and effectiveness, potential side effects, and the expertise and qualifications of the practitioner. Although some practices are beneficial, others may be harmful to certain patients.

Alternative treatments should not be used as a substitute for medical therapies prescribed by a doctor. Parents should discuss these techniques and treatments with the child's doctor to determine the remedies that may be beneficial for the child.

Nutritional concerns

An adequate intake of folic acid (vitamin B9) has been linked to the prevention of stroke and heart disease by lowering homocysteine, an amino acid related to the early development of cardiovascular disease when high levels are present in the blood. Dietary sources of folic acid include: vegetables, especially green vegetables; potatoes; cereal and cereal products; fruits; and organ meats (liver or kidney). It is best to eat fresh fruits and vegetables whenever possible to get the most vitamins. Recommended daily intake in micrograms (mcg) for folic acid supplements (oral tablets) include: 25–100 mcg in newborns to age three; 75–400 mcg in children aged four to six; 100-400 mcg in children aged seven to 10; and 150–400 mcg in children aged 11 and above.

Vitamin K is an important nutrient needed to regulate normal blood clotting. A diet deficient in vitamin K can cause prolonged blood-clotting time and easy bleeding and bruising. Vitamin K is found in: alfalfa, asparagus, broccoli, Brussels sprouts, cabbage cheddar cheese, green tea, green leafy lettuce, liver, seaweed, spinach, and turnip greens. Recommended daily intake for vitamin K supplements (for patients not on anticoagulant therapy) include: 10 mcg in newborns to age three; 20 mcg in children aged four to six; 30 mcg in children aged seven to 14; 65 mcg in boys and 55 mcg in girls aged 15–18; 70–80 mcg for males over age 18 and 60–65 mcg for females over age 18. If the patient is taking anticoagulant medications, vitamin K supplements are not recommended, and foods high in vitamin K are limited, since they counteract the action of the medication.

Vitamin E and beta carotene supplements were once thought to help decrease the risk of stroke and prevent the development of heart disease, but newer studies disprove their effectiveness. Researchers at The Cleveland Clinic Heart Center performed a meta-analysis of seven large randomized trials of vitamin E (given alone or in combination with other antioxidants) and eight of beta carotene. All trials included 1,000 or more patients and follow-up ranged from 1.4 to 12 years. The doses of vitamin E given in these trials ranged from 50–800 international units (IU) and 15–50 milligrams (mg) for beta carotene. The meta-analysis reviewed the effect of these antioxidants on death from cardiovascular disease or from any other cause ("all-cause mortality").

Their findings, published in the June, 2003 issue of The Lancet journal, do not support the continued use of vitamin E supplementation nor the inclusion of vitamin E in further studies. Regardless of the dosage given or the patient population, Vitamin E did not provide any benefit in lowering mortality compared to control treatments, and it did not significantly decrease the risk of cardiovascular death or stroke (cerebrovascular accident). In addition, they recommend that vitamin supplements containing beta carotene be "actively discouraged" because of the small but statistically significant increased risk of death. Researchers discourage further study of beta carotene because of the mortality risk.

Even though studies have demonstrated that vitamin E and beta carotene supplements do not reduce stroke risk, foods rich in antioxidants are still encouraged because they also contain beneficial nutrients such as flavonoids and lycopenes that are not usually included in standard oral vitamin supplements. A diet rich in antioxidant-containing foods, such as fruits, vegetables and whole grains, is linked to a reduced risk of cardiovascular disease.

Dietary supplements should not be used as a substitute for medical therapies prescribed by a doctor. Parents should discuss these nutrition supplements with the child's doctor to determine the remedies that may be beneficial for the child.