Pediatric Strokes Are More Common Than You Think

September 27, 2019

Childhood stroke affects about 1 to 8 in 100,000 children in the western hemisphere. Most children are diagnosed with stroke during early childhood, before age 5, although strokes may happen at any age from childhood to adulthood1.  

What Causes Pediatric Strokes?

Pediatric stroke has been associated to risk factors such as sickle cell disease, congenital heart disease, hypercoagulability syndromes, arteriopathies or genetic syndromes. However, previously healthy children may also suffer from strokes. Very commonly, strokes in previously healthy children are frequently associated to focal arteriopathies in relation to recent infections, increasing the risk of a stroke 6-fold in children who may be otherwise predisposed2

What Are the Symptoms of Pediatric Strokes?

Strokes in childhood may mimic more common diseases such as migraine, epilepsy, brain infections or tumors with symptoms of headache, seizures, inability to walk or talk. For this reason, when evaluating a child with face, arm or leg weakness, difficulty speaking or new onset focal seizures, our neurologists keep stroke in mind as a potential cause. Our team works along the doctors in the emergency department to expedite the diagnosis of stroke by activating our stroke clinical care guideline. Our team aims to recognize stroke rapidly as emerging research therapies may provide the opportunity to treat stroke in children presenting to the emergency department3 soon after the onset of symptoms.

How Are Pediatric Strokes Treated?

When a child is diagnosed with stroke, our pediatric neurocritical care team4 in conjunction with the pediatric intensive care unit, will provide comprehensive evaluation and treatment to improve outcomes. Our team, aims to improve outcomes by instituting a neuroprotective approach, starting with fluid, temperature, blood pressure, glucose management as well as providing neuromonitoring5 as some children affected with stroke may have a higher risk for seizures. All while finding the cause of a stroke to help determine the risk of recurrence. Children may have recurrent strokes in up to 10% of cases, with the highest risk of recurrence around 1 year after their first stroke. Some children may require a blood thinner to reduce the likelihood of a recurrent stroke for 2 years or longer after their stroke. Children with stroke are followed closely in our outpatient clinic and our team, works closely with our rehabilitation colleagues to obtain the best outcome possible. Our team has active research participation through StrokeNET, a multicenter initiative lead by NIH, with the goal of advancing acute stroke treatment, stroke prevention and recovery and rehabilitation following a stroke.

Learn more about Lurie Children’s Neurocritical Care Program

 

References
  1. Ferriero DM, Fullerton HJ, Bernard TJ, et al. Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke. 2019;50(3):e51-e96.
  2. Fullerton HJ, Hills NK, Elkind MS, et al. Infection, vaccination, and childhood arterial ischemic stroke: Results of the VIPS study. Neurology. 2015;85(17):1459-1466.
  3. Sun LR, Felling RJ, Pearl MS. Endovascular mechanical thrombectomy for acute stroke in young children. J Neurointerv Surg. 2019;11(6):554-558.
  4. Wainwright MS, Grimason M, Goldstein J, et al. Building a pediatric neurocritical care program: a multidisciplinary approach to clinical practice and education from the intensive care unit to the outpatient clinic. Semin Pediatr Neurol. 2014;21(4):248-254.
  5. Kurz JE, Smith CM, Wainwright MS. Thermoregulate, autoregulate and ventilate: brain-directed critical care for pediatric cardiac arrest. Curr Opin Pediatr. 2017;29(3):259-265.