Childhood strokes going undetected

For the first time in decades, reports show that while the elderly are suffering fewer strokes, strokes among younger populations, even children, are on the rise.

The American Stroke Association found that there has been a 30 percent increase in strokes in girls and boys ages five to 14. If childhood stroke is not shocking enough, they can even happen in the womb or to infants

Jamie Finnerty, 15, is not a lightweight by any measure; he plays both rugby and football in his free time. It was not until he took a hard hit a few months that knocked him off his feet.

“I felt like the world was spinning a thousand miles an hour,” said Jamie. The impact of the hit tore an artery and caused the teen to suffer a stroke.

Neil Friedman, a Pediatric Neurologist at Cleveland Clinic said, “They thought it was a migraine, so it was 24 hours later they realized he had a stroke.”

This delay in diagnosis is not uncommon. According to the National Stroke Association, on average, it takes 12 to 24 hours for adults to make it to the hospital after the first indication of a stroke. The delay increases to 48 to 72 hours for children exhibiting signs.

Friedman says, “Childhood stroke often goes unrecognized.” The signs of pediatric stroke can be difficult to diagnose. Until recently there has been very little to help a child who has suffered a stroke, but some of the known underlying factors include heart disease, blood disorders, trauma, and even chicken pox.

Studies are currently underway to use the adult stroke drug T.P.A in children with brain clots. Dr. Neil Friedman says that the clot busting medicine needs to be administered within four and a half hours of the stroke. He warns that even if T.P.A works and improves signs of the stroke, there still remains a concern about hemorrhage or bleeding in the brain.

Unfortunately for Jamie, by the time he made it to a doctor it was too late to use T.P.A to help treat his stroke. However, children’s brains have the ability to rewire quicker and more completely than adults. Jamie is perfect proof, just three months after his stroke Jamie was walking, talking and ready to get back to school and sports.

“It’s kind of cool to say everything that happened I’m standing here, I’m doing all this and I’m getting back to normal,” said Jamie.

Dr. Friedman says that Jaime suffered from a second stroke while he was in rehab. A side effect of the blood-thinning medication he was taking caused his brain to bleed. In the case of this second stroke, Dr. Friedman says T.P.A would not be useful.

Another shocking fact about strokes is that people have the highest chance of having a stroke during the first week of life than at any other time. Dr. Friedman says that the first week of infancy has the highest rate of stroke. Most often it is not recognized until the baby is five or six months old and begins favoring one side of the body over another.

RESEARCH SUMMARY:
FIGHTING PEDIATRIC STROKES
REPORT #1928

PEDIATRIC STROKE: Stroke affects about 6 in 100,000 children and is the leading cause of death in children in the United States. 60% of pediatric strokes occur in males and strokes in children are different from those in adults; where adults are more likely to have ischemic strokes, children have hemorrhagic strokes just as often as they have ischemic strokes.

RISK FACTORS: Risk factors for strokes in children are different from those in adults. Some common risk factors of stroke in children are diseases of the arteries, infection, acute or chronic head and neck disorders, abnormal blood-clotting, and sickle-cell disease. Over the past 13 years there has been an increase in traditional cardiovascular risk factors for stroke in people between the ages of 15 and 34, including high blood pressure, diabetes, obesity, cholesterol-related disorders, tobacco use, and alcohol use. This could help explain why stroke in younger individuals is increasing.
SIGNS: It is important to recognize the signs of a pediatric stroke so the child can receive the proper treatment as quickly as possible. It is especially hard to know when a pediatric stroke has occurred in babies or very young children since they cannot voice concerns themselves. Here is what to look out for:

1. Seizures can signal a stroke, especially in newborns.
2. Worsening or sudden headaches, although this can be difficult to tell in babies.
3. Sudden difficulty speaking or slurring of words, or trouble understanding others' speech.
4. Weakness on one side of the body.
5. Sudden loss of vision or abnormal eye movements.
6. Sudden loss of balance or difficulty walking. (Source: www.stroke.org)

TREATMENTS AND TPA: Treatment of pediatric stroke depends on what caused the stroke to occur. Treatment with an antithrombotic agent such as aspirin or forms of heparin can help children with blood vessel abnormalities, while others benefit more from surgical treatments like a bypass procedure. However, treatment can be difficult for children who have hemorrhagic stroke because they have a completely different set of problems from the bleeding in the brain. (Source: Dr. Heather Fullerton, www.ucsfbenioffchildrens.org) TPA stands for tissue plasminogen activator and is normally given through intravenous injection. TPA is used to treat ischemic stroke and is usually given through a vein on the arm and can help dissolve the blood clot causing the stroke, but is not a safe means of treatment for hemorrhagic stroke and could put them at risk of bleeding in the brain. (Source: www.mayoclinic.com)

For More Information, Contact:

Neil Friedman MBCHB
Pediatric Neurologist
Cleveland Clinic
(216) 444-6772


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