Introduction:
Pediatric stroke is a condition that affects newborns and infants. It is of very rare nature. It may affect one in every 4000 children. A stroke can be caused due to hemorrhage (excessive bleeding) and ischemia (lack of blood supply to a particular region). A stroke can mainly occur following an injury. This condition can occur when there is less blood supply to a particular area in the brain. The treatment mainly depends on the severity and the area of the brain that is affected due to the stroke.
Stroke in neonates is a medical emergency. It requires utmost and immediate care. If not attended to, this condition can even be life-threatening. It may even lead to permanent neurological damage leading to various motor and cognitive impairments.
What Are the Various Risk Factors for Pediatric Stroke?
The various risk factors for stroke in children include:
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All newborn babies, including full-term born infants.
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Neonates or children born with other conditions such as sickle cell anemia (red blood cell is in sickle shape), immune system disorders, and disorders in which the clotting mechanism is affected.
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Disorders of the blood system may cause narrowing of the blood vessel.
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Constriction of blood vessels that causes reduction of blood supply.
What Are the Types of Pediatric Strokes?
The various types of pediatric strokes include-
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Arterial Ischemic Stroke: There could be a blood flow blockage to the brain that is caused due to injury or accidents. Sometimes, a blood clot can also cause a narrowing of the artery.
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Intracranial Hemorrhage: Intracranial hemorrhage is a condition in which there is bleeding inside the brain. In some cases, the arteries that carry blood to the brain can burst, causing hemorrhage. This happens when the walls of the arteries weaken due to various factors.
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Cerebral Sino Venous Thrombosis (CSVT): In some cases, a thrombosis (clot) can cause blockage of the arteries that supply the brain. This can cause impairment of brain function. This impairment can further lead to stroke.
What Are the Signs and Symptoms of Pediatric Stroke?
The signs and symptoms of stroke in children and teenagers include-
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Numbness or weakness on one side of the face or body. This is usually a tell-tale sign of stroke.
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Severe vomiting.
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The blurring of vision.
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Headache along with dizziness.
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Stammered speech. The child may find it difficult to communicate simple things.
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Difficulties in understanding.
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Difficulty in walking can be seen as a loss of balance or coordination. There can also be difficulty in moving only one side of the body. This can also be seen as the tendency to use only one side of the body for all activities.
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Loss of consciousness or excessive sleepiness.
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In stroke, there is usually a progressive worsening of the condition.
In newborns and infants, the symptoms include-
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Excessive sleepiness.
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The infant does not have a coordinated movement of the hand and legs—the tendency to move only one side of the body.
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Decreased movement of the hand and legs.
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Presence of seizures.
How Is Pediatric Stroke Diagnosed?
If a child is known to experience symptoms of stroke, the pediatrician may run a series of test to evaluate the condition quickly. The faster the treatment, the better the prognosis. Mostly, the diagnosis is achieved by a combination of tests that may be undertaken. The various tests that are taken to diagnose the condition are:
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Imaging Tests: To diagnose stroke, the doctor may perform various imaging tests such as X-rays, CT scans (computed tomography scan), and MRI scans (magnetic resonance imaging). These tests can help in imaging the blood vessels that are responsible for the stroke.
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Catheter Angiogram: This is a specialized test that is used to visualize the blood supply. In this test, a special dye is injected into the artery that provides a contrast. Later, imaging is done to visualize the artery and the contrast. This test helps in finding conditions such as ischemia.
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Echocardiogram: This is a test performed that is used to analyze the blood flow through the chamber of the heart.
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Blood Investigations: Various blood investigations can be performed that help in detecting bleeding and clotting disorders. These disorders could be an underlying factor for intracranial hemorrhage or ischemia.
How Is Pediatric Stroke Treated?
Based on the diagnostics, the most appropriate treatment plan will be developed. The treatment can include a wide panel of doctors, such as pediatricians, neurologists, hematologists (specialists in blood disorders), and neurosurgeons.
The main aim of the treatment is to establish a healthy blood flow in the brain. The treatment is usually a combination of various protocols, which may include:
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Medications: A combination of drugs can be given to the child. This can include a blood thinner used to treat the blockage or ischemia. Anticoagulants can be prescribed to prevent the formation of a thrombus in case of clots. Other medications may include- multivitamins, anti-seizure medications (in the case of a seizure), and other medications depending on the underlying condition. Sometimes, a clot-dissolving medication is used for immediate relief.
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Interventional Neuroradiology: This is a type of minimally invasive procedure when the arteries supplying the brain are connected in an abnormal fashion. This procedure is even performed if there is an aneurysm (weakening or bulging of the arterial wall). In interventional neuroradiology, a catheter is placed in the arterial wall. The catheter helps in expanding the blood vessel wall and regulates the flow of blood.
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Surgery: In some cases of stroke, surgery may be required. This surgery may be necessary when the blood vessels supplying the brain are abnormally placed or have other complications such as a blockage or ballooning. In such cases, partial craniectomy may be performed to ease the condition.
Conclusion:
Pediatric stroke is a medical emergency that requires the utmost medical attention. It can occur due to multiple factors, such as a lack of blood supply or bleeding in the brain. This condition needs immediate medical care. The earlier the treatment received, the better the prognosis.
