Stroke in children – risk factors and treatment methods.
Karolina Łozińska
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According to the World Health Organization’s definition, a stroke is a set of clinical symptoms characterised by the sudden onset of a focal, localised — and sometimes generalised — disturbance of brain function, whose symptoms last longer than 24 hours and have no cause other than a vascular one. In children, a stroke occurs far less often than in adults, but it remains a serious clinical problem.
It is estimated that the problem affects around 3 children per 100,000 studied over the course of a year. The first research into stroke in children was carried out as early as the 1970s. It indicated that ischaemic stroke accounted for around 45% of cases of disturbed brain function, and in the 21st century this proportion has risen to around 50% of all cases of stroke in children.
Although ischaemic stroke in children is many times less common than in adults, vascular disturbances of brain function are a significant cause of movement disorders, speech difficulties requiring speech therapy, and developmental delay and difficulties at school that can have a marked effect on the child’s future.
- Movement disorders, including paresis of one or both sides of the body and epileptic seizures, depending on the location of the vascular damage in the brain, often involving paresis of the hand and upper limb.
- Difficulties with expressive speech, ranging from problems producing individual words to a complete absence of speech.
- Developmental delay and difficulties at school that significantly affect the child’s further functioning.
Stroke in children – generalised symptoms
- Headaches, more often present in the acute phase of haemorrhagic stroke episodes.
- Disturbances of consciousness.
- Vomiting and convulsions.
- Hemiparesis, cranial nerve palsies and other symptoms depending on the topography of the ischaemic focus.
- Speech disorders.
Stroke in children – risk factors
In children, the risk factors for acute cerebral ischaemia are still poorly understood, and the cause often remains unclear. The most commonly cited factors are heart disease, injuries, chronic inflammatory conditions, systemic connective tissue diseases, proliferative disorders of the haematopoietic system and vascular malformations.
In around 20–30% of children, even after thorough investigation it is still not possible to identify a single group of causes responsible for the ischaemic stroke. Markers indicating a thrombotic mechanism may also be significant, such as the platelet count, blood density, the activity of clotting factors, reduced activity of clotting inhibitors, resistance to activated protein C and the presence of antiphospholipid antibodies.
The most important groups of risk factors
- Congenital heart defects, such as aortic valve stenosis, mitral valve stenosis, cardiac myxoma and complex heart defects.
- Acquired heart disease, including rheumatic disease, endocarditis, cardiac arrhythmias and Kawasaki disease.
- Systemic vascular diseases, including hypertension, diabetes, progeria and atherosclerosis.
- Inflammatory diseases, such as meningitis, chickenpox, systemic lupus and rheumatoid arthritis.
- Conditions involving vascular spasm, for example migraine and subarachnoid haemorrhage.
- Factors of haematological origin, such as cancers, leukaemias, impaired liver function and oral contraception.
- Injuries, including battered child syndrome, fat or air embolism, injuries to the carotid arteries, injuries to the oral cavity, arteriography and penetrating intracranial injury.
These are some of the most common factors behind ischaemic disturbances of the brain, grouped according to when the condition originates and where it occurs.
Stroke in children – treating the stroke and care afterwards
Therapeutic care in the acute phase of an ischaemic stroke should begin as soon as possible and be carried out alongside the diagnostic process. Appropriate care in the first few days — or even hours — has a decisive effect on the prognosis.
Epileptic seizures in the acute phase of a stroke require anticonvulsant treatment. Current methods for treating ischaemic stroke in children depend on the cause and may include anticoagulant and antiplatelet treatment, blood transfusions and surgical treatment.
One of the fundamental elements of a child’s speediest possible return to functioning in society is neurological rehabilitation for children. Depending on their age, the patient should be looked after by a team that includes a physiotherapist, a speech and language therapist and a doctor.
Care should be based on getting the child, their carer and the therapist working together as early as possible, as part of comprehensive neurological rehabilitation programmes. This involves activation, restoring range of movement in the joints and muscle strength, working on spatial orientation, awareness of one’s own body and body mapping, and rebuilding basic movement and articulation patterns.
Depending on the deficits, the team of therapists should work with the carer to set the goals of therapy and decide which functions to prioritise first. It is also important to involve the child not only during therapy sessions, but also in everyday activities and ordinary life.
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