Pediatric cerebrovascular accident (CVA) or stroke occurs when blood flow to the brain is interrupted either by a rupture of the blood vessel (hemorrhagic stroke) or by a blood clot (ischemic stroke) and can affect children of any age. Although they are not very frequent, it is important to learn about the symptoms, risk factors and treatment of this disease. Dr. Pamela Muñoz, pediatric neurologist of our clinic, provides us with valuable information on this subject.
- According to the age of onset, ischemic stroke is classified as: Neonatal, when it is diagnosed between 20 weeks of gestation and 28 days of life. Postnatal arterial, when it occurs after 28 days of life and presumed perinatal, which is detected in children older than 28 days, usually due to motor asymmetry and when imaging tests show an old infarct probably produced in the pre- or perinatal period.
- It can be caused by heart disease, infections, coagulation disorders, trauma, genetic abnormalities, metabolic diseases, and vascular anomalies.
- Symptoms vary depending on the area of the brain affected and the age of the child. Some warning signs are weakness or paralysis on one side of the body, difficulty speaking or understanding, loss of vision, severe headache, seizures, altered consciousness or behavior, hyperacute headache (the worst headache you have ever felt), dizziness and unsteadiness.
- Diagnosis is based on the child’s presenting symptoms, neurological examination, and imaging tests such as computed tomography and magnetic resonance imaging.
- Treatment depends on the type and cause of the stroke. It may include anticoagulation or antiplatelet therapy, stabilization of the child in an intensive monitoring unit to prevent respiratory and/or cardiac complications, maintaining good hydration, warning of possible seizures, or treating swelling or cerebral edema. In some cases, the patient may need surgery to remove the hemorrhage or repair the injured blood vessels if vascular malformations are present.
- The recovery process of the child is variable: it depends on the extent of the brain injury, age, and possible complications.
- Rehabilitation is multidisciplinary: neurological, cardiological, hematological control, psychological counseling (both for the child and the family). In addition to physical rehabilitation, cognitive, learning and memory therapies to avoid physical, emotional, and social sequelae, among others.
- Some sequelae are temporary, others permanent. They mainly affect motor skills, language, learning, memory, attention, mood, and interpersonal relationships.
- Many children who have had a stroke can relearn how to use their arms, legs and speech with brain retraining. This process can be slow and requires perseverance.
If your child has suffered a stroke, you are not alone. Doctors and therapists will be there to help him/her, do not hesitate to ask all the necessary questions to clear your doubts. Look for support groups, if you consider it necessary.
Dr. Pamela Muñoz,
Pediatric neurologist at Clínica Ricardo Palma