Strokes

What Are Strokes?

A stroke (sometimes called a "brain attack") happens when blood flow to the brain stops, even for a second.

Blood carries oxygen and other important substances to the body's cells and organs, including the brain. In an ischemic (ih-SKEE-mik) stroke, these substances can't get to the brain and brain cells die. This can permanently damage the brain and make a person's body stop working as it should.

In a hemorrhagic (heh-meh-RA-jik) stroke, a blood vessel in the brain breaks, flooding the brain with blood and damaging brain cells.

Who Gets Strokes?

Many of us think that strokes only happen in adults, especially older adults. But kids can have strokes too. Although they're less common in kids, strokes can happen in children of all ages, even those who haven't been born yet.

Strokes in children most often happen within the first month after birth. These are sometimes called perinatal (or neonatal) strokes. Most perinatal (pair-ih-NAY-tul) strokes happen during delivery or right after delivery when the baby doesn't get enough oxygen while traveling through the birth canal.

Strokes also can affect older kids. But most of these are caused by another condition that stops the flow of blood to the brain or causes bleeding in the brain.

What Causes Strokes?

Finding the cause of a stroke in a child can be hard. Strokes in adults often happen because of high blood pressure, diabetes, or atherosclerosis. The risk factors for stroke in children are more varied.

Ischemic strokes are the most common type in children. They're usually related to:

• lack of oxygen during birth
• a heart defect the baby is born with
• blood disorders such as sickle cell disease, which destroys blood cells and blocks blood vessels
• injury to an artery (a blood vessel that brings oxygen) in the brain
• dehydration
• genetic disorders like Moyamoya, a rare disease that affects arteries in the brain
• an infection, such as meningitis or chickenpox

Some problems that affect a mother during pregnancy can cause a baby to have an ischemic stroke before or after birth. These include:

• preeclampsia (high blood pressure during pregnancy that can cause swelling in the hands, feet, and legs)
• premature rupture of the membranes (when a woman's water breaks more than 24 hours before labor starts)
• diabetes
• infections
• drug abuse
• placenta problems that decrease the baby's oxygen supply, such as placental abruption

Hemorrhagic strokes can be caused by:

• a head injury that causes a broken blood vessel
• arteriovenous malformation, a condition in which the blood vessels in the brain don't connect properly
• an aneurysm (weakness in an artery wall)
• diseases that affect blood clotting, such as hemophilia

What Are the Signs & Symptoms of a Stroke?

Signs of a stroke in older children are often similar to signs in adults, such as:

• sudden weakness
• slurred speech
• blurred vision

Babies who have a perinatal stroke often don't show any signs of it until months or years later. In some cases, they develop normally, but at a much slower pace than other kids. They also might tend to use one hand more than the other.

Children whose perinatal strokes cause more brain injury might have seizures. The severity of seizures can vary, ranging from the child simply staring into space to violent shaking of an arm or leg.

Signs of a strokein infants:

• seizures in one area of the body, such as an arm or a leg
• problems eating
• trouble breathing or pauses in breathing (apnea)
• early preference for use of one hand over the other
• developmental delays, such as rolling over and crawling later than usual

A seizure may be the first sign that an older child or adolescent has had a stroke. These children might also have sudden paralysis (inability to move) or weakness on one side of the body, depending on the area of the brain that's affected and the amount of damage the stroke causes. More likely, a parent first notices changes in the child's behavior, concentration, memory, or speech.

Common signs of strokein kids and teens:

• seizures
• headaches, possibly with vomiting
• sudden paralysis or weakness on one side of the body
• language or speech delays or changes, such as slurring
• trouble swallowing
• vision problems, such as blurred or double vision
• tendency to not use one of the arms or hands
• tightness or restricted movement in the arms and legs
• trouble with schoolwork
• memory loss
• sudden mood or behavioral changes

If your child has any of these symptoms, see a doctor right away or call 911. Kids who are actively having a stroke can be given medicine that might reduce the severity of the stroke and the brain damage it can cause.

How Is a Stroke Diagnosed?

Perinatal and early childhood strokes can be hard to diagnose, especially if a child has no clear signs or symptoms. In some cases, a stroke is found to be causing seizures or developmental delays only after many other conditions have been ruled out.

If stroke is suspected, a doctor will probably want the child to have one or more of these tests:

• blood tests
• magnetic resonance imaging (MRI): a safe and painless test that uses magnets, radio waves, and computer technology to produce very good pictures of internal body parts, such as the brain
• magnetic resonance angiography (MRA): an MRI of specific arteries
• magnetic resonance venography (MRV): an MRI of specific veins
• computed tomography scan (CT or CAT scan): a quick and painless test that produces pictures of bones and other body parts using X-rays and a computer
• computed tomography angiography (CTA): an X-ray of specific arteries
• cranial ultrasound: high-frequency sound waves that bounce off organs and create a picture of the brain
• lumbar puncture (spinal tap)

How Are Strokes Treated?

Treatment for a stroke is based on:

• the child's age
• what signs and symptoms the child has
• which area of the brain is affected
• how much brain tissue was damaged
• whether an ongoing condition caused the stroke

Many different treatments are possible. For example:

• A child who has seizures may need anti-seizure medicines.
• A child with a heart defect might need blood-thinning medicine.

For most kids, treatment also involves:

• physical medicine and rehabilitation, or physiatry (fiz-ee-A-tree). Physiatrists (fiz-ee-A-trists) are doctors who use many different types of therapy to help children recover from a stroke. They work to enhance and restore functional ability and quality of life in people who have medical conditions that affect the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and tendons.

What Problems Can Happen?

Brain damage from a stroke can cause a number of problems, some of which can be lasting, such as:

• cerebral palsy
• cognitive and learning problems
• paralysis or weakness on one side
• communication problems
• vision problems
• psychological problems

Kids who've had a stroke will see doctors who specialize in helping people cope with these problems. These specialists might include:

• occupational therapists
• physical therapists
• speech therapists

A physiatrist might oversee the child's care.

What Else Should I Know?

At this time, there's no treatment that can fix brain cells that have died. But undamaged brain cells can learn to do the jobs of cells that have died, especially in young people.

In many cases after a stroke, kids can learn to use their arms and legs and speak again through brain retraining. This process is usually slow and difficult. But kids have an edge over adults because their young brains are still developing. Most kids who have had strokes can interact normally and be active members of their communities.

How Can I Help My Child?

If your child had a stroke, you aren't facing his or her rehabilitation and future care alone. The doctors and therapists who will work with your child are there to support the whole family. Don't hesitate to ask questions about your child's condition or treatment or to ask for help when you need it.

Also look for support groups for parents of kids who have had strokes, such as:

• Children's Hemiplegia and Stroke Association
• University of Colorado Pediatric Stroke Parent Support Group

The input and support from other parents facing the same challenges can help you find the strength you need to help your child get the best care possible.