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different types of stroke
different types of stroke
some common causes of paediatric stroke
some common causes of paediatric stroke
Perinatal stroke due to maternal risk factors
Mostly not understood but can be caused by pre-eclampsia, oligohydramnios, prolonged rupture of the membranes and chorioamnionitis
Birth trauma
Can cause stress to the vessels, brain and the heart leading to higher risk of stroke
Transient cerebral arteriopathy
The transient stenosis of a cerebral vessel. TCA is thought to be caused by an inflammatory process related to infections, such as varicella-zoster virus (VZV), enterovirus, human immunodeficiency virus (HIV), and Borrelia burgdorferi.
Vasculitis
Inflammation of the blood vessels causing thickened vessel walls and limited blood flow.
It is thought to be caused by an immune response.
Congenital Heart Disease
Any form of congenital heart disease could result in the heart not pumping efficiently leading to blood becoming stagnant within the heart and clots forming.
Patients may also have a direct shunt (either congenital or acquired) from the venous system to the aorta increasing risk of emboli to the brain (See PFO)
Patent Foramen Ovale
If it is still open into childhood, there is a direct connection between the right heart and the left heart. Therefore, if the patient suffers from DVT these emboli could reach cerebral arteries.
Sickle Cell Disease and other blood clotting disorders
The sickled cells can cause a clot in arteries.
Atrial Fibrillation
One of the smaller heart chambers doesn’t pump in a coordinated way. Blood then stagnates and clots can form.
Neck artery dissection due to genetic conditions
A dissection or tear in a neck artery can form a clot at the break in the artery wall. Although dissections are uncommon, the tear can be caused by damage to the neck, or by genetic risk factors such as fibromuscular dysplasia and vascular Ehlers–Danlos syndrome.
Vascular malformations
An arteriovenous malformation (AVM) is an abnormal tangled connection between arteries and veins.
A cavernous malformation is a tangle of tiny blood vessels creating a weak-walled ‘cavern’ of blood.
Both these conditons can lead to weak blood vessels with the risk of rupture.
Trauma and tumours
Could cause disease in the heart, brain or vessels resulting in either kind of stroke.
ECMO
Increased risk of blood clotting within the ECMO circuit.
(2)
what age is most common?
what age is most common?
Up to 120 babies and 400 children have a stroke in Australia each year.
Stroke is more common in newborns and young babies than older children.
Stroke affects one in 2300 to 5000 newborns.
Around a third of all strokes in children occur under one year of age. (1)
signs and symptoms
signs and symptoms
Children have similar signs and symptoms to adults. The difficulty is that children have a lot more differential diagnoses and when they are younger it may be harder to recognise changes in walking, talking and behaviour.
Babies:
Seizures.
Extreme sleepiness.
In babies, there may not be signs while the stroke is happening. You may notice changes in the way the baby develops over time, like using only one side of their body.
Toddlers, children and teenagers:
Weakness or numbness in the face, arm or leg, especially on one side.
Difficulty talking, understanding, reading or writing.
Trouble seeing or loss of vision.
Dizziness, loss of balance or poor coordination.
Severe or unusual headaches, nausea or vomiting.
Difficulty swallowing, including drooling.
Seizures with weakness that doesn’t improve.
Changes in behaviour and difficulty concentrating.
Stroke can sometimes cause children to collapse. (1)
references
references
https://strokefoundation.org.au/about-stroke/learn/childhood-stroke/about-childhood-stroke
Mark T Mackay, Anne Gordon (2007) Stroke in children, Australian Family Physician Vol. 36, No. 11
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