Stroke risk in kids a reality
Q: I saw a billboard about early recognition of stroke in adults. Does this apply to children too? Why would a child ever have a stroke?
A: It is a strange thing to think about, but kids can indeed have strokes. A stroke occurs when a portion of the brain is deprived of blood supply, either due to either a blockage in one of the arteries perfusing the brain or hemorrhage in the brain. The signs of a stroke in children are the same as in adults. These include facial asymmetry, slurred speech, weakness on one side of the body, seizures or loss of consciousness. There is a nationwide Public Service campaign geared at early recognition of stroke. The acronym F.A.S.T. sends the right message. F – facial asymmetry. A – Arm weakness. S – Slurred speech. T – Time to call 911! Pediatric stroke physicians advocate expanding this to F.A.S.T.R. R is for “Remember, kids can have strokes too!”
The occurrence of stroke is much less frequent in children (2-13/100,000) than in adults (120-600/100,000). High risk populations include children with cancer, congenital heart disease or inflammatory disorders of the blood vessels. The cancers most strongly associated with stroke are blood and brain cancers. Children with any kind of heart disease have some risk for stroke, especially during procedures such as cardiac catheterization or heart surgery. Lupus and Juvenile Rheumatoid Arthritis are examples of conditions which cause inflammation of arteries. Most children will not have any of these conditions, thankfully, but some will. All of us likely know a child with a chronic medical issue, or will come across one when out and about, so it behooves us to remember that children can have strokes too.
Early recognition of stroke is of paramount importance because some of the injured brain can be saved. The central portion of the affected brain is called the core, and the surrounding tissue is called the penumbra. The core tissue is most affected by the decreased blood flow of a stroke event. This brain tissue usually dies.
However, the penumbra is often salvageable if therapies are instituted promptly. Current therapies include neuroprotective measures, TNA and thrombectomy. The latter two are time sensitive and must be
done within 4 and 6 hours respectively of when the child was last seen looking normal. This is why early recognition and quick access to care is so important for all patients with stroke, and especially for kids.
Why especially for kids? Because whatever deficits in learning, speech, emotional control or motor function occur as a result of the stroke will be with that child for many, many years. And these years are often key for growth and development, learning how to read and write, learning how to socialize, learning how to learn even. A child with a stroke, and their family, will have to live with the resulting deficit for the rest of their lives. Which is why minimizing that deficit by using the available therapies is so vitally important.
A big problem with pediatric stroke is delay in diagnosis. This occurs because of people being unaware that kids can have strokes, and because of stroke mimics. Stroke mimics are neurologic conditions that present with findings like facial asymmetry or weakness on one side of the body, but the underlying cause is not a stroke. Some examples include seizures, hemiplegic migraines, episodic hypertensive crises, increased intracranial pressure or brain tumors. Some of these, like seizures, are usually easily treated without much consequence. Others, like brain tumors, are serious and need to be addressed immediately. Either way, when a child presents with acute neurologic changes, immediate brain imaging and discussion with a pediatric neurologist is the right next step.
Pediatric stroke is a difficult subject, a condition that I think of as low frequency but very high impact. That is why it is imperative to raise public awareness that strokes can happen in kids. Early recognition and quick access to pediatric stroke doctors give these kids the best chance for a good recovery. The best thing one can do as a caregiver or parent is to immediately call either 911 or the child’s doctor and say, “I think my child is having a stroke”. Using those exact words will trigger a rapid series of events which may save valuable brain tissue and preserve valuable brain function, affording that child an opportunity for a bright future. For more information please see http:// www.stroke.org Anjali Subbaswamy is a Pediatric Intensive Care Physician at UNM. Please send your questions to her at asubbaswamy@salud.unm. edu