Cerebrovascular
Disease (Stroke)
What
is it?
Cerebrovascular disease, or
stroke, is the death of brain tissue that occurs
when the brain does not receive enough blood flow
and oxygen.
Who
gets it?
Cerebrovascular disease, or
stroke, occurs in approximately 1.2 to 2.5 out of
every 100,000 children each year.
Stroke may occur at any age, but in childhood it most
often occurs between the ages of 1 and 5.
What
causes it?
Stroke occurs when the blood
supply to the brain is cut off.
This could be because a blood vessel is
blocked, called an ischemic stroke, or because a
blood vessel bursts, called a hemorrhagic stroke.
When the blood vessel bursts, it prevents
normal blood flow to the brain and allows blood to
leak into an area of the brain, where it destroys
tissue. The
most common cause of stroke in children is
congenital cyanotic heart disease and sickle cell
disease. However,
drugs, such as cocaine and amphetamines, can
narrow the blood vessels and cause stroke.
What
are the symptoms?
Symptoms of stroke in
children vary according to where the blood supply
was cut off in the brain or where the bleeding
occurred. Many
conditions that lead to stroke result in emboli,
which are blood clots that form in the heart, then
break free and travel through the arteries to the
brain. Symptoms
always involve neurological functions, and can
include paralysis affecting only one side of the
body (hemiplegia), general weakness, impaired
speech and verbal comprehension (dysphagia ),
partial loss of vision or hearing, unusual
movements, loss of balance, and falling.
Most strokes begin suddenly and symptoms develop quickly.
Less commonly, symptoms may continue to
worsen for several hours. Symptoms
of stroke can also include coma or a lower level
of consciousness, such as a stupor.
Strokes can cause depression, mood and
behavioral disturbances, and seizures.
Because stroke causes damage to the brain tissue, the
neurological damage is more likely to be
permanent.
However, while some brain cells die, resulting in permanent
damage, others may only be injured and may
eventually recover.
How
is it diagnosed?
Stroke
is usually diagnosed by physical examination and a
description of the symptoms.
The doctor will try to pinpoint where the
brain was damaged by performing tests such as
computed tomography (CT) or magnetic resonance
imaging (MRI) scans.
CT and MRI scans can also help rule out a
brain hemorrhage or tumor.
Your doctor will take into consideration
your child’s age and any pre-existing cardiac,
vascular, or brain disorders.
Your doctor will want to determine whether
the stroke was ischemic or hemorrhagic.
Strokes caused by blood clots (ischemic
strokes) are frequently followed by other strokes
unless the problem is corrected.
If your child is having seizures, an EEG
may be ordered to check brain function. Your
doctor may also order an electrocardiogram or
echocardiogram if your child has a pre-existing
heart condition.
Because stroke can occur if inflammation or
infection narrows the blood vessels leading to the
brain, your doctor will want to rule out
meningitis, encephalitis, brain abscess, bleeding
inside the skull, and migraines as causes of the
stroke symptoms.
Neurodegenerative disorders, such as
adrenoleukodystrophy, can also have symptoms
similar to stroke.
What
is the treatment?
Strokes require immediate
medical treatment.
At first, the goal will be to maintain and
support your child’s pulmonary, cardiovascular,
and renal functions. Your
child will receive oxygen and intravenous fluids.
Heart rate and rhythm and blood pressure
will be monitored carefully. Specific
treatment depends upon the cause of stroke.
If the stroke is in process or known to be
caused by embolism, an anticoagulant like heparin
or warfarin is given to thin the blood.
However, anticoagulants are not used where
there is any possibility of bleeding in the brain.
Another
treatment may include a small daily dose of
aspirin. However,
because aspirin use in children carries with it a
risk of Reye’s syndrome (a rare disorder that
causes brain inflammation), aspirin treatment
should only be used when recommended by and under
the supervision of your doctor.
In cases of sickle cell disease,
researchers have noted some success in preventing
stroke by using periodic blood transfusions to
suppress the level of circulating sickle
hemoglobin to 30% or less.
If your child has had a stroke, the
long-term treatment involves rehabilitation and
therapy to help overcome any lasting disabilities
in language and motor skills.
Children who continue to suffer from seizures may also
require anticonvulsant treatment.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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