Stroke Health Article

Prognosis

Cerebrovascular disorders are among the top 10 causes of death in children, with rates highest in the first year of life. From 1979 to 1998 in the United States, childhood mortality from stroke declined sharply, by 58 percent, with reductions in all major subtypes: ischemic stroke decreased by 19 percent, subarachnoid hemorrhage by 79 percent, and intracerebral hemorrhage by 54 percent.

Some children survive a pediatric stroke with no life-long consequences. In other children, long-term complications of stroke may develop right away or within months to years after a stroke. According to a 2000 study published in the Journal of Child Neurology, the outcome of childhood stroke was a moderate or severe deficit in 42 percent of cases. Adverse outcomes after childhood stroke—including death in 10 percent, recurrence in 20 percent, and neurological deficits in two-thirds of survivors—can be reduced with available stroke treatments.

When a stroke affects a child whose brain is still developing, it is thought that the developing brain may be able to compensate for the functions that were lost as a result of a stroke.

Recovery from stroke is different with each child. Overall, the degree of permanent disability after a stroke is less in children than in adults. Speech and language problems usually improve rapidly in the first year after a stroke. Children may only have minor delays in the development of coordinated movement or in cognitive functioning. Almost all children recover the ability to walk independently after a stroke, unless there is another condition that causes disability. Recovery of function in the affected arm and hand is usually the most significant movement problem after a stroke. Most children who suffer from a stroke can expect to lead independent lives as adults.

Prevention

Despite current treatment, one out of 10 children with ischemic stroke will have a recurrence within five years. Although there is a high risk of repeat strokes in patients with sickle cell anemia, the risk can be reduced with regular blood transfusions. If no cause of the stroke was identified, the risk of a recurrence is low. If a cause was identified, the underlying condition should be treated, and anticoagulant or low-dose aspirin therapy may be initiated, depending on the child's diagnosis.

There is no screening for stroke, but screening exists for many of its risk factors. To prevent stroke, risk factors should be treated and managed by the child's primary care doctor or specialist. The doctor can advise if specific preventive treatment is needed.

Management of high cholesterol—especially high LDL (low-density lipoprotein) levels—high blood pressure and diabetes can help reduce the risk of a stroke.

Parental concerns

It is common for a child to feel sad or depressed after a stroke. These emotions may be the result of not knowing what to expect or not being able to do simple tasks without becoming overly tired. Temporary feelings of sadness are normal, and should gradually go away within a few weeks, as the child starts a rehabilitation program and returns to some of his or her normal routines and activities.

When a depressed mood is severe and accompanied by other symptoms that persist every day for two or more weeks, the parent should ask for a referral to a mental health professional who can help the child cope and recover. There are many treatments for depression. A healthy lifestyle including regular exercise, proper sleep, a well-balanced diet, as well as relaxation and stress management techniques can help manage depression. Major depressive disorder may be treated with antidepressants, psychotherapy (supportive counseling or "talk therapy"), or a combination of both.

Regular follow-up visits with the child's health care provider will help identify and manage risk factors and other medical conditions. If the child has a known medical condition that increases the risk of stroke, it is important for parents and caregivers to learn the warning signs and symptoms of stroke in children and infants. If the child experiences any unexpected neurological problem, the parent should have the child evaluated by a physician. Lastly, it is important for parents to carefully follow the child's treatment plan, including following the medication schedule exactly as prescribed.

BOOKS

Burkman, Kip. The Stroke Recovery Book: A Guide for Patients and Families. Nebraska: Addicus Books, Inc., May, 1998.

Senelick, Richard C., Peter W. Rossi, and Karla Dougherty. Living with Stroke: A Guide For Families: Help and New Hope for All Those Touched by Stroke. New York: McGraw-Hill/Contemporary Books, June, 1999.

Zimmer, Judith and John P. Cooke. The Cardiovascular Cure: How to Strengthen Your Self-Defense Against Heart Attack and Stroke. New York: Broadway Books, August, 2002.