Cerebral Vascular Accidents
Cerebral vascular accidents (CVA’s, or a stroke) occur primarily in the adult population and are relatively rare in children but can lead to significant morbidity and mortality.
Cerebral vascular accidents (CVA’s, or a stroke) occur primarily in the adult population and are relatively rare in children, but can lead to significant morbidity and can even be fatal. A stroke presents itself differently in children in comparison to adults and early recognition of the symptoms is critical for positive outcomes. However, due to variations in presentation, it is not uncommon for a stroke to be diagnosed until 15 hours to 3 months after initial symptoms.
Overall, 1.2 to 13 cases per 100,000 children under the age of 18 will suffer from a stroke, and the rate of pediatric strokes has more than doubled from previous decades. While this may sound like cause for alarm, the rise in numbers can be explained by improved recognition of symptoms and increased survival in children with risk factors for stroke (congenital heart disease, sickle cell disease, leukemia, and premature birth).
The most common type of stroke in children is an acute ischemic stroke (AIS). AIS strokes account for approximately 50% of the strokes in children. Up to 25% of children with a stroke will have a recurrence, and up to 66% will have persistent neurological deficits, develop subsequent seizure disorders, or learning and developmental problems. AIS most often presents in the following ways:
- Focal neurological deficit, with hemiplegia (paralysis on one side of the body) being the most common manifestation (up to 94% of cases).
- Seizures (in up to 50%)
- Hemorrhagic strokes most commonly present with the following:
- headaches or altered level of consciousness
- seizures (in up to 50%)
Age also plays an impact on the presentation of stroke as well. The younger the child, the more nonspecific their symptoms may be. Perinatal strokes more likely present with focal seizures or lethargy in the first few days after birth. During the first year, the child may demonstrate lethargy, apnea spells, or hypotonia (low muscle tone). Toddlers may present with a general deterioration of their condition, increased crying and sleepiness, irritability, feeding difficulty, vomiting, and sepsis-like symptoms with cold extremities. Older children demonstrate symptoms more similar to adults, like hemiparesis, language and speech difficulties, visual deficits, and headache.
Intensive inpatient rehabilitation following stroke can lead to improved outcomes. LifeScape offers expert rehabilitation following stroke for children and adolescents, with clinicians trained in specialized, evidence-based treatments, in both inpatient and outpatient settings. One example is Constraint Induced Movement Therapy (CIMT) for hemiparesis. It involves restraining the unaffected upper extremity and using only the affected extremity. CIMT can be done at any time, but is most effective relatively soon after the injury and can be repeated multiple times.