Guidelines focus on dealing with children’s strokes

Seizures are a more common symptom of strokes in children than in adults.

Chicago Tribune

CHICAGO — The American Heart Association for the first time has issued guidelines to physicians on the diagnosis and treatment of stroke in infants and children.

In releasing its first scientific statement on the subject, the group noted that strokes are more common in children than previously thought and that the causes, risks and symptoms differ greatly from those in adults.

In newborns, for example, the first symptoms of stroke often are seizures that involve only one arm or leg, said Dr. E. Steve Roach, chairman of the task force that developed the guidelines. Seizures involving one limb are so common that stroke is believed to account for about 10 percent of seizures in full-term newborns, he said.

Seizures are much less common in adults as a symptom of stroke.

About 10 in every 100,000 children in the United States will suffer a stroke in any given year, said Roach, neurologist in chief at Nationwide Children’s Hospital in Columbus, Ohio.

The risk in children is greatest in the first year of life, particularly in the first two months. About one in every 3,000 or 4,000 full-term newborns suffers a stroke, Roach said.

Only people over age 65 have a higher stroke risk than babies less than a month old, he said.

“It’s not that we’re seeing more strokes,” said Dr. Michael Kohrman, associate professor of pediatrics and neurology at the University of Chicago Medical Center. “What we’re recognizing and have come to understand is that stroke is a major cause of disability in children, especially infants and premature infants. In the past, we called it cerebral palsy and intracranial hemorrhaging. But what we’re really talking about is different forms of strokes.”

The most common risk factors for childhood stroke are sickle cell disease and birth defects of the heart. Other conditions that can lead to stroke include dehydration, head trauma, head and neck infections and systemic problems such as inflammatory bowel disease and autoimmune disorders.

Doctors suspect that risk factors derived from the mother for infant stroke include a history of infertility, pregnancy-related high blood pressure, a premature rupture of membranes and infection in the amniotic fluid surrounding an unborn baby.

In contrast, risk factors for strokes in adults include diabetes, artery disease, atrial fibrillation, cigarette smoking, high blood pressure and being older than 55, the heart association paper said.

About 80 percent to 85 percent of strokes in adults in Western industrialized countries are caused by blood clots. In children, almost half are caused by bleeding in the brain.

“The best way to improve the functioning of children is to find out why they had the stroke and fix the underlying problem before they have stroke No. 2 or 3,” Roach said.

More than half of children who have a stroke have a known risk factor, and the risk factors often are discovered in children who have not yet had a stroke after a thorough evaluation. Stroke also can occur before birth.

“If your 80-year-old aunt became weak on one side, everybody in the household would say, ‘Oh my goodness, she’s had a stroke,’ and rush her to the emergency room,” Roach said. “If the same thing happened to a 6-year-old child, the family doesn’t put two and two together.”

That way of thinking is true for many doctors as well. The guidelines are meant to educate doctors so they can more quickly recognize when a child has had a stroke, which would greatly cut the risk for brain damage, disability and death.