Stroke in children (Paediatric stroke) ~ Diagnosis, Treatment and Rehabilitation ~

(If you missed last week's post, you can find it here.)

Diagnosis of paediatric stroke

A quick diagnosis is important to minimize risk for brain damage. Doctors rely on imaging machines and other tests to see what has happened in a child’s brain.  

• Computed Tomography (CT) scan uses X-rays to take a detailed picture of the affected area of the brain. A CT scan will confirm whether or not the child has had a stroke, what kind of stroke it is and where in the brain it occurred.  
• Magnetic Resonance Imaging (MRI) uses magnetic radio waves to create an image of the brain. It provides greater visual details than a CT scan.  
• Cerebral Arteriogram uses a special dye injected into the arteries of the brain and an X-ray is then taken.  
• Echocardiogram uses sound waves to take pictures of the heart to see whether there are problems with the heart valves or other heart functions that may be creating blood clots.  
• Blood tests may also be ordered to find out whether your child has a blood-clotting disorder.  
• Lumbar puncture (also known as a spinal tap) to find out if there are signs of infection or inflammation in the nervous system.

Treatments of stroke in children

In children who have had a hemorrhagic stroke, treatment focuses on stabilizing the child (controlling blood pressure and body temperature, and helping them breathe), and treating the hemorrhage itself. Children who have had an ischemic stroke may need to go on blood thinners.

Treatment for hemorrhagic stroke Kids who have had a hemorrhagic stroke will be looked after by the vascular neurosurgery team. Surgical options may include microsurgery to clip the aneurysm or remove the abnormal vessels.

Treatments for ischemic stroke The goal of treatment in ischemic stroke is to reduce damage to the brain and prevent another stroke. If your child has been diagnosed with an ischemic stroke, doctors will most likely prescribe a blood thinner. These include: 

• Coumadin (warfarin) , given by mouth
• Heparin, given by injection into a vein
• Low molecular weight heparin, given by injection under the skin
• Acetylsalicylic acid (Aspirin or ASA), given by mouth
• Clopidogrel (Plavix), given by mouth

Once a child has been treated for their initial stroke symptoms, they will be assessed to see how the stroke may affect them in the longer term. The healthcare team will monitor reflexes, eye movements, speech skills, swallowing and other body functions. The team may also administer tests to find out how well your child is doing in processing and reacting to light, pictures, sound and touch.

Newborns generally don’t require treatment for stroke, although they may be treated for heart problems, if that is the source of their illness.

What are the possible effects of a stroke? 

Stroke often causes after-effects in children. They include:  

• weakness on one side of the body (hemiparesis)
• paralysis on one side of the body (hemiplegia)
• one-sided neglect, where the child ignores the weaker side (unilateral neglect)
• difficulty with speech and language (aphasia)
• trouble swallowing (dysphagia)
• vision problems (decreased field of vision or perception)
• loss of emotional control and mood changes
• problems with memory, judgment or problem-solving (cognitive changes)
• behavioural or personality changes

Physical effects usually occur on the opposite side of the body from where the stroke occurred. For instance, children who have had a stroke affecting the left side of their brain may have weakness or paralysis on the right side of their body. The left side of the brain controls reading, talking, thinking and doing math, so these skills could be affected.

On the other hand, children who have had a stroke affecting the right side of their brain, may have paralysis or weakness on the left hand side of their body. The right side of the brain controls skills such as buttoning a shirt or tying shoes, as well as memory.

In children who have experienced a stroke, changes in physical abilities may be immediately apparent, but changes in cognition and behaviour tend to be discovered over time. Often children do recover faster than adults because their brains are still growing. This is called plasticity. If children are quite young when they have a stroke, the extent of their deficits may not become apparent until they are older. For example, a reading problem may not be discovered until your child is in grade 1.

You and your child may feel overwhelmed, angry, depressed or frightened, which are all normal reactions. Speak to your hospital’s healthcare team about counselling options for your child and yourself.

What rehabilitation programs are available?

The purpose of rehabilitation is for your child to recover physical functions such as walking or reading. Getting help as soon as possible after the stroke maximizes recovery in children. Children are likely to regain the most function in the first six months. They may continue to improve for two years or more. Speak to your hospital’s healthcare team about rehabilitation options.

Over several Wednesdays I will offer information on the following - 

• Anatomy of the Brain, √  Anatomy of the Brain, part 2 √
• Ischemic Stroke √ 
• Transient Ischemic Attack (TIA or mini-stroke) - part 1 √  Transient Ischemic Attack (TIA or mini-stroke) - part 2 √
• Hemorragic Stroke √
• Stroke in children (Paediatric stroke) - Causes √ 
• Stroke in Children (Paediatric Stroke) - Diagnosis, Treatment and Rehabilitation √ 
• Effects of a stroke

 All information contained in this post was obtained, with permission, from the Heart and Stroke Foundation  website. Please visit their site for more information.

Monica

Disclaimer

The material provided on this site is designed for information and educational purposes only. The materials are not intended to be a self diagnostic and/or self treatment tool. I encourage you to use this information as a tool for discussing your condition with your health practitioner.