Battling Heart and Stroke

Stroke in babies? No. that can’t be. When we think of stroke, we know the risk factors involved: excess weight, bad nutrition, excessive alcohol consumption, lack of exercise, and cigarette smoking. So how can babies suffer from stroke?

Apparently, stroke in children is not that common but not that rare, either. The risk of stroke from birth till the18th year of life is 10.7 per 100,000 children per year.

Last month, the American Heart Association issued a scientific statement on the management of stroke in infants and children.

What are the differences between adult stroke and children stroke?

Type and incidence: In adults in western countries, 80 to 85% of stroke cases are ischemic where it is about 55% in children. The rest are hemorrhagic.

Symptoms: In children, seizure is a common symptom of stroke not observed in adults. About 10% of seizures in full-term babies are due to stroke.

Treatment: It is highly recommended that adults suffering from ischemic stroke be treated with the medication tissue plasminogen activator (t-PA). t-PA is a clot-busting agent that should be administered within 3 hours of the onset of symptoms. This medication is not yet ready for pediatric use and still needs to be tested.

Risk factors: Risk factors for adult stroke are listed above. The most common risk factors for childhood stroke are sickle cell disease, congenital or acquired heart disease, and chronic anemia. Associated conditions include:

• infections including varicella (chicken pox), meningitis, tonsillitis, and otitis media (middle ear infection)
• leukocytosis, and prothrombotic disorders
• systemic conditions such as inflammatory bowel disease and autoimmune disorders
• head trauma
• dehydration.

Sickle cell disease is a risk factor common to both adults and children.

There are also maternal factors that can influence an infant’s risk for stroke and these include a history of maternal infertility, infection in the fluid surrounding the fetus (chorioamnionitis), premature rupture of membranes, and pregnancy-related hypertension (preeclampsia).

Prevention: Primary prevention is highly feasible in adults. Lifestyle change is the main preventive strategy in adult stroke, followed by medication therapy. In children, prevention is to reduce the likelihood of subsequent strokes after the first one has been correctly diagnosed. Primary prevention is only possible when the underlying condition such as sickle cell disease or congenital heart disease is already known. Children with sickle cell disease 221 times more likely to suffer stroke, according to AHA.

The AHA recommendations for the prevention of subsequent stroke in children are as follows:

Children with ischemic stroke who also have migraines may be evaluated for other stroke risks. Common migraine isn’t likely linked to stroke, but migraine with aura seems to increase risk.

It is reasonable to counsel children with stroke and their families about the benefits of a healthy diet, exercise and avoiding tobacco products.

It is reasonable to suggest an alternative to oral contraceptives after a stroke or cerebral venous sinus thrombosis (CVST).

Children with brain hemorrhage not caused by trauma should undergo a thorough risk factor evaluation, including standard cerebral angiography when noninvasive tests have failed to establish a cause to identify treatable risk factors before another hemorrhage occurs.

Parents can get more information about childhood stroke by downloading this AHA brochure Let’s Talk About Children and Stroke.

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