विवरण
Stroke is a condition that is often associated with older adults, but it can also occur in children. A stroke in children occurs when blood flow to the brain is interrupted, causing brain damage. There are two types of stroke in children, ischemic stroke and hemorrhagic stroke. Ischemic stroke is the most common type and occurs when a blood clot blocks a blood vessel in the brain, while hemorrhagic stroke occurs when a blood vessel in the brain ruptures and causes bleeding. The causes of stroke in children can vary, but some common risk factors include congenital heart disease, sickle cell anemia, and infection. Symptoms of a stroke in children may include weakness or numbness on one side of the body, difficulty speaking or understanding language, and severe headaches. Treatment for a stroke in children typically involves medications to dissolve blood clots or prevent further blood clots from forming, as well as rehabilitation to help the child regain lost abilities. It is important for parents and caregivers to be aware of the signs and symptoms of stroke in children, as early intervention can improve outcomes.
सारांश
- Pediatric stroke is an acute cerebrovascular event occurring in children aged 28 days to 18 years. It includes arterial ischemic stroke (AIS), venous sinus thrombosis, and hemorrhagic stroke (non-traumatic intracerebral hemorrhage or subarachnoid hemorrhage), and presents with nonspecific symptoms, mandating neuroimaging for diagnosis.
- Clinical awareness is vital for prompt management. Risk factors are multifactorial and differ from adults. Stroke is defined by the World Health Organization as rapidly developing clinical signs of focal cerebral dysfunction lasting over 24 hours. Perinatal stroke occurs from 28 weeks gestation to 28 postnatal days, while childhood stroke occurs after that up to 18 years of age.
- Stroke mimics include hypochloremia, epilepsy, multiple sclerosis, metabolic disorders, migraine, and intracranial tumors or infections. Distinguishing stroke from stroke-like conditions involves assessing deficit location, onset, neurological features, and consciousness level. Neuroimaging (CT or MRI) and angiography are crucial for confirming stroke and identifying vascular obstructions.
- Risk factors for infantile hemiplegia include cardiac conditions (congenital heart disease, endocarditis), hematological causes (anemia, thrombocytopenia), infections (otitis media, meningitis), vasculitis (SLE, immune vasculitis), genetics (MELAS, Fabry disease), neurocutaneous syndromes (Sturge-Weber), and other factors (nephrotic syndrome, dehydration).
- Arterial ischemic stroke (AIS) results from infarction in an arterial territory, commonly due to thrombotic or embolic phenomena, with cardiac disease and arteriopathy being frequent causes. Focal cerebral arteriopathy (FCA) is characterized by arterial insulation and stenosis, potentially triggered by infections, and is treated with aspirin.
- Clinical features vary based on stroke location: anterior circulation (hemiparesis, aphasia) vs. posterior circulation (ataxia, vertigo). Brainstem stroke syndromes present specific cranial nerve deficits and motor/sensory impairments based on the affected area (midbrain, pons, medulla).
- Investigations for AIS include CT/MRI brain with angiography, complete blood count, peripheral smear, ESR, blood sugar, LFT, RFT, coagulation profile, and cardiac evaluation. Second-tier investigations involve lipid profile, transcranial Doppler, and pro-thrombotic workup. Third-tier tests, tailored to etiology, include metabolic, vasculitis, mitochondrial, and genetic studies.
- Acute stroke treatment includes supportive care (airway, breathing, circulation), temperature/oxygenation maintenance, and avoidance of hypo/hyperglycemia. Relative hypertension should only be lowered in specific situations. Cerebral edema management requires careful monitoring. Early mobilization and rehabilitation are crucial.
- Treatment of AIS involves supportive care, antiplatelet therapy, anticoagulation therapy, and recanalization therapy. Long-term management includes neurorehabilitation, seizure control, and secondary stroke prevention with antiplatelets or anticoagulants. TPA use in children is controversial and requires clinical trials. Evidence supports treating specific underlying causes like Fabry disease or homocystinemia.
- Hemorrhagic stroke, comprising about half of childhood strokes, is caused by vascular malformations. Investigations include CT/MRI brain with angiography and digital subtraction angiography. Treatment involves stabilization, supportive care, reversing coagulopathy, and neurosurgical intervention.
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Dr.Bharat Parmar
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