Childhood Stroke

Evidence

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8219494/

Mary Hollist, Katherine Au, Larry Morgan, Padmashri A Shetty, Riddhi Rane, Abraham Hollist, Angela Amaniampong, and Batool F Kirmani

Strokes can occur at any age or stage in life. Although it is commonly thought of as a disease amongst the elderly, it is important to highlight the fact that it also affects infants and children.

Education

What is childhood stroke?

A stroke is when blood cannot get to all parts of your child’s brain. If this happens, your child’s brain can be injured.

Blood carries oxygen and nutrients for your brain cells.

Blood flows through your blood vessels. Blood vessels are like tubes or pipes. Blood vessels can be blocked. They can break or burst.

If blood cannot get through, brain cells start dying and your brain can be injured. Stroke can happen at any age.

Perinatal stroke happens before birth or shortly after birth, between 28 weeks of pregnancy and one month old.

Childhood stroke happens in a child aged from one month to eighteen years old.

Are strokes common in children?

• Up to 600 children will have a stroke each year in Australia.
• Stroke is more common in newborns and young babies than older children.
• Stroke affects one in 2300 to 5000 newborns.
• Around a third of all strokes in children occur under one year of age.

Types of strokes

There are three main types of strokes:

1. Ischaemic stroke is caused by an artery being blocked by a blood clot.
2. Haemorrhagic stroke is caused by bleeding when a blood vessel breaks.
3. Cerebral sinovenous thrombosis causes blood clots in the veins within the brain.

For more information about the types of strokes, please visit https://enableme.org.au/Resources/Types-of-stroke

Stroke signs

If you notice any of these signs, call triple zero (000) immediately.

Babies:

• Seizures.
• Extreme sleepiness.

In babies, there may not be signs while the stroke is happening. You may notice changes in the way your baby develops over time, like using only one side of their body.

Toddlers, children, and teenagers:

• Weakness or numbness in the face, arm or leg, especially on one side.
• Difficulty talking, understanding, reading or writing.
• Trouble seeing or loss of vision.
• Dizziness, loss of balance or poor coordination.
• Severe or unusual headaches, nausea or vomiting.
• Difficulty swallowing, including drooling.
• Seizures with weakness that doesn’t improve.
• Changes in behaviour and difficulty concentrating.
• Stroke can sometimes cause children to collapse.

If you notice any of these signs, call triple zero (000) immediately. Even if you aren't sure, or the signs disappear, call triple zero (000).

Causes of stroke

Causes of stroke in children are different to those in adults. Medical conditions can increase the risk of a child having a stroke. It is not always possible to find the cause of a stroke in babies and children. Some parents worry that they did something to cause their child's stroke. This isn't the case.

Perinatal stroke:

• Pregnancy complications.
• Difficulties during birth.
• Infections.
• Blood clotting disorders in mother or baby.
• Heart problems.

Childhood stroke:

Problems with the brain's blood vessels can increase the risk of stroke.

• Vasculitis can cause a blood vessel to become narrow or weak.
• Focal Cerebral Arteriopathy (FCA) can cause blood vessels to become narrow.
• Head and neck trauma can cause blood clots to form or cause blood to leak from the vessel.
• Moyamoya disease can cause blood vessels to become narrow and blocked.
• An arteriovenous malformation (AVM) is a tangled mass of blood vessels in the brain that can burst.
• An aneurysm is a weak or thin spot on an artery wall that can burst.
• A cavernous malformation is a cluster of abnormal blood vessels in the brain that can leak.
  
  

Problems with the heart or heart surgery can increase the risk of stroke. Blood clotting or other disorders can also increase the risk.

How does stroke affect children?

A child’s brain controls everything they think, feel, say and do. How stroke affects them depends on the area of their brain that was injured and how badly. The effects are different for every child.

The most common effects include difficulties with:

• Walking, moving or using their arm.
• Swallowing.
• Speaking, understanding, reading, writing.
• Thinking, memory, judgment.
• Personality, behaviour, emotions.
• Vision, touch, taste, smell
• Fatigue.

Effects may be minor, or they may be more serious. A child’s brain is continuously developing and changing. Effects of stroke in a baby or very young child may become more obvious over time.

Recovery is usually most rapid in the weeks and months after their stroke, but recovery can continue for years. Starting rehabilitation early increases a child’s changes of a good recovery.

Paediatric Stroke Treatment

Your child may receive treatment to minimise the injury to the brain and the risk of another stroke. The type of treatment your child receives depends on the type of stroke, the time passed since the stroke and their age.

Ischemic stroke

• Reperfusion therapies are early treatments to dissolve or remove the clot and return the blood supply to the brain.
• Thrombosis is a medication is given to dissolve the clot.
• Endovascular thrombectomy is the physical removal of the clot from a large artery.

These treatments are common after stroke in adults but are less commonly used in children. Research is still being done to determine how these treatments affect children and which children might benefit.

Medications to make the blood thinner and less likely to clot may be given, particularly in children with heart conditions.

Surgery may be needed to relieve pressure on caused by swelling in the brain.

Haemorrhagic stroke

Surgery may be need to:

• Repair the damaged artery and stop the bleeding.
• Relieve the pressure caused by the build up of blood. This may include removing part of the skull until the welling reduces.

Surgery may also be needed to seal or remove:

• A weak or thin spot on an artery wall (aneurysm).
• A tangled mass of blood vessels (arteriovenous malformation or AVM).

Empowerment

Follow-up care is extremely important. Once your child is stabilized, your health care team will work with you to create an ongoing plan to assess your child’s function and optimize recovery.

Depending on where in the brain the stroke occurred, your child may experience difficulties with walking, seeing, speaking, or reading, sometimes with one side of the body affected more than the other. The stroke may cause a seizure disorder or have an impact on your child’s thinking or emotions.

Prompt diagnosis and treatment can minimize the risk of lasting problems, and early rehabilitation can help maximize recovery. While recovery is usually most rapid in the first few weeks and months, children can continue to improve for years after their stroke.  

Useful Links

Stroke Foundation

Find more information and answers to your questions about childhood stroke

www.strokefoundation.org.au/About-Stroke/Learn/Childhood-stroke

Stroke Foundation’s Childhood Stroke Project has developed a new resource for pre- and primary school aged children. The All brains are beautiful fact sheet aims to educate friends, relatives and families on the impact of stroke in children and promote inclusion.

https://strokefoundation.org.au/about-stroke/learn/childhood-stroke/resources

Little Stroke Warriors is a group of families and survivors of childhood stroke. It provides families and carers with a supportive community to help steer them through the journey of stroke recovery.

Follow Little Stroke Warriors https://www.facebook.com/littlestrokewarriorsaustralia

Parents, carers and survivors of childhood stroke over the age of 18 can join the Facebook support group  https://www.facebook.com/groups/littlestrokewarriors

Special thanks to the Stroke Foundation Australia for content sharing and linking to provide further information and direction for families with any concerns.

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