Strokein children is not a common condition. Statistics on their incidence vary, but the most common estimate is that they occur in 1-2 per 100,000 children. It is likely, however, that the statistics do not fully reflect the true state of affairs - it is likely that some of the strokes that occur in children are not diagnosed at all. This may be because the symptoms of a stroke in children - as will be discussed later - may be considered to be symptoms of an entirely different condition.

Strokes can occur in adolescents as well as in newborns, and it can also happen that a foetus experiences a stroke while still in the womb. The fact that this condition can occur at any age is due to the different factors that can lead to it.

Causes of strokes in children

There are generally two types of stroke in children: ischaemic strokes and haemorrhagic strokes. In the case of the former, any problems arise due to the fact that no blood can reach the nerve tissue and no oxygen can reach it. In a short period of time, only a few minutes, the nerve cells die. There are many causes of ischaemic stroke in children:

• perinatal hypoxia,
• congenital heart defects,
• haematological disorders (such as sickle cell anaemia),
• damage to the vessels supplying blood to the brain (caused, for example, by various injuries),
• infections and their complications (meningitis and chickenpox may be particularly predisposing to stroke).

Slightly different disorders are the causes of a different type of stroke, namely haemorrhagic strokes. In this case, dangerous extravasation of blood within the skull may be caused by problems such as:

• haematological diseases associated with impaired blood clotting (such as haemophilia),
• trauma resulting in rupture of brain vessels,
• rupture of a previously present aneurysm in the cerebral vessels.

As can be seen, the potential causes of stroke in children are numerous. Interestingly, however, in some patients it is not possible to definitively detect the factor that actually led them to develop this disease.

photo: panthermedia

Stroke in children - symptoms

In the course of a stroke in a child , some of the symptoms are the same as in an adult stroke, however, some disorders may be different in young patients, such as the occurrence of fever. However, the majority of symptoms for both age groups are similar and symptoms of a stroke in a child include:

• paresis or paralysis (especially of the limbs, typically occurring on one side of the body),
• visual disturbances,
• difficulty speaking,
• dizziness,
• nausea,
• headache (sometimes extremely severe),
• balance disorders,
• problems with concentration,
• difficulty playing,
• a sudden change in the child's behaviour - they may become lethargic and apathetic,
• impaired swallowing (this may be accompanied by drooling),
• seizures.

A stroke can also occur in a newborn baby - in the case of such a patient, speech disorders will not occur for obvious reasons, nor will the newborn complain to his/her parents that he/she has started to see less well. It is for these reasons that in the youngest children - newborns and infants - the diagnosis of stroke is particularly difficult. Problems that may be indicative of this particular disease are sudden changes in the child's behaviour (e.g. a marked decrease in activity). Parents should also be concerned if they notice that their child has suddenly started to have problems moving a part of the body, such as a hand or a leg.

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Diagnosis of a suspected stroke in a child

The primary investigations ordered when a child is suspected of having a stroke are imaging studies - a CT scan of the head or magnetic resonance imaging of the head. Already these examinations make it possible to ascertain the possible existence of stroke-related brain lesions, but a number of other examinations are also necessary in young patients in order to detect the cause of the disease. These may include echocardiography, lumbar puncture or EEG, as well as laboratory tests (e.g. to assess coagulation parameters or markers of possible infection).

However, one very important point should be emphasised here. Strokes in children are indeed rare - even if a patient develops symptoms that may be related to this condition, it is first necessary to exclude more common diseases that may lead to a similar clinical picture. The differential diagnosis of strokes in children includes various neurological conditions (such as migraine), but also various metabolic disorders and many other entities.

Treatment of stroke in a child

In a child who has suffered a stroke, immediate treatment is required - the disease is a life-threatening condition and delaying the start of treatment will only worsen the patient's prognosis. Treatment of stroke in children varies, depending on the form of the disease in the individual patient. For ischaemic strokes, restoration of blood flow to the brain is required. On the other hand, for those patients who develop a haemorrhagic stroke, surgery is sometimes required to evacuate blood from inside the skull.

Prognosis: Can a child recover from a stroke?

The prognosis of children who experience a stroke varies widely - it is extremely individual and depends, among other things, on the form and extent of the stroke, but also on how quickly the patient was treated. Post-stroke rehabilitation in children is required, which can sometimes take many months. One piece of news, however, is definitely reassuring - in children the chances of achieving improvement and minimising neurological losses as a consequence of stroke are significantly higher than in adults.