Introduction
Although stroke is relatively uncommon in children, it can still have a significant impact on morbidity and mortality. To optimize the possible outcomes for children it is necessary to recognize how strokes in children present differently from those in adults and the specific risk factors. Despite an increase in the frequency of pediatric stroke, cases may still go undiagnosed or receive an incorrect diagnosis because of the frequent delay in treatment. Depending on the child's age, the clinical presentation will change, and kids have different risk factors for stroke than adults do.
What Is Stroke?
The occlusion or rupture of cerebral blood vessels results in a neurological injury known as a stroke. An ischemic, hemorrhagic, or combined stroke are the types. Although venous occlusion of cerebral veins or sinuses is less common than arterial occlusion as a cause of ischemic stroke. Hemorrhagic stroke is caused by bleeding into the site of an acute ischemic stroke or from a ruptured cerebral artery (AIS). When compared to adults, where 80 to 85 % of all strokes are ischemic and AIS accounts for about half of all strokes in children. Additionally, children who are primarily affected by hypertension, diabetes, and atherosclerosis have a more varied and significant number of risk factors for stroke compared to adults.
Significant morbidity and mortality result from pediatric stroke. Around 10 to 25 % of children who have a stroke die, up to 25 % will experience another stroke, and up to 66 % will experience neurological deficits that last a lifetime or develop seizure disorders, learning disabilities, or other developmental issues. Neurological consultation, imaging, and treatment help in the early recognition of pediatric stroke.
What Are the Signs and Symptoms of Stroke in Children?
The most typical AIS symptom is a focal neurologic deficit. With up to 94 % of cases, hemiplegia (paralysis on one side of the body) is the most frequent focal manifestation. In contrast to AIS, hemorrhagic strokes are more likely to result in vomiting and typically present as headaches or an altered level of consciousness. Both ischemic and hemorrhagic strokes frequently involve seizures. They do not just affect one age group or one type of seizure, they can happen in up to 50 % of kids with strokes.
Based on the age of the child, there may be substantial differences in the clinical presentation. More vague symptoms may be present in younger children. Focal seizures or lethargy are more frequently the initial symptoms of perinatal strokes in the first few days after birth. Infants within the first year of life can still present acute lethargy, apnea (sleep disorder), or hypotonia (reduced muscle tone), even though focal neurological deficits from these events may not manifest for weeks or months. Additionally, infants can exhibit a wide range of symptoms, including a decline in their overall health, an increase in crying and sleepiness, irritability, difficulty eating, vomiting, and sepsis-like symptoms with cold extremities.
More specific neurological defects, similar to those in adults, are seen in older children. Hemiparesis (one sided weakness), speech and language issues (such as aphasia), headaches, and visual impairments. A transient ischemic attack is characterized by symptoms that last less than 24 hours (TIA). Deficits are frequently short-lived and can end within an hour. Older kids might even be able to recall earlier instances of odd signs or symptoms. According to recent data, 33% of children who had arterial strokes had TIAs that were undiagnosed at the time that the stroke occurred.
What Is the Differential Diagnosis of Stroke in Children?
A stroke can be a symptom of a wide variety of other illnesses. If there is a family history of migraine or hemiplegic migraine, complicated migraines may cause focal neurologic symptoms that typically go away within 24 hours. Focal seizures can lead to subsequent transient postictal hemiparesis (Todd's Paresis). But stroke should be taken into account if the duration of the deficit is excessively long in comparison to the length of the previous seizure. It is important to rule out intracranial tumors as well as infections like meningitis, brain abscesses, and herpes simplex encephalitis as well as intracranial diseases like intracranial neoplasms. Even though it is extremely uncommon, alternating hemiplegia is a possibility, particularly if there is a clear history of episodes of hemiplegia that rarely last longer than a day. Focal deficits resembling a stroke can result from common metabolic abnormalities like hypoglycemia. Without an actual ischemic or hemorrhagic event, uncommon metabolic disorders like MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke), which are inherited, can also produce stroke-like symptoms.
What Are the Diagnostic Tests of Stroke in Children?
It is essential to get a quick and accurate evaluation by a neurologist or a pediatrician when a child exhibits symptoms of stroke in order to start treatment and reduce the risk of long-term complications.
For a proper diagnosis, imaging tests on the brain and blood vessels like computed tomography (CT) or magnetic resonance imaging (MRI) are extremely important.
Additional examinations to determine the cause of the stroke could consist of:
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Catheter angiogram.
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Blood tests for clotting disorders.
How Is Stroke Treated?
The etiology will determine the type of stroke and its course of treatment. Additional medical management beyond supportive measures may be necessary for hemorrhagic strokes. Coagulation errors and hematologic disorders must be corrected in order to prevent rebleeding. It has been demonstrated that recombinant factor VIIa stabilizes intracerebral hematomas and decreases hemorrhage volume. Recombinant factor VIIa promotes hemostasis. Adult studies have not shown any evidence of a better outcome in terms of functional outcome or survival. More prospective studies in adults are still required to ascertain whether specific patient subgroups may benefit from this therapy.
Conclusion
With the advancement of diagnostic tools and increased clinician awareness, strokes in children are being recognized more frequently. It is still difficult to develop evidence-based diagnostic and treatment guidelines for children because the incidence is still low compared to adult strokes. Future research on stroke must be pursued with an international and national collaborative effort due to the low incidence of this disease. Until then, stroke should continue to be a serious concern in kids with alarming symptoms and significant risk factors, and the best research should be used to deliver the best possible medical care.
