Stroke in children: what are the first signs?

If cerebrovascular accidents (CVA) primarily concern adults (it is the third cause of death after cancer and myocardial infarction in people over 18), these strokes also affect children, although this is rarer. Approximately 1,000 children and infants are victims each year. If few children die from it (about 10%), this pathology is the leading cause of acquired disability in children. A strokealso called a “brain attack”, occurs when the normal circulation of blood is interrupted and that a region (more or less important) of the brain ceases to receive its usual supply of blood. It occurs most often (80%) by obstruction (ischemic stroke) or by the rupture of a blood vessel (hemorrhagic stroke). What causes the nerve cell death and the loss of brain function. Warning symptoms, treatments, consequences and sequelae.

At what age does stroke occur in children?

First of all, you should know that pediatric stroke can take place:

► during the perinatal stage: we then speak of fetal stroke, before birth (in practice, fetal stroke occurs during the 3rd trimester of pregnancy), and neonatal stroke, from birth to the 28th day after pregnancy. birth. “Of the 1,000 children who have strokes each year, the half are newborns less than 28 days old“, specifies Dr. Céline Bellesme, neuro-pediatrician at the CHU Kremlin-Bicêtre;

► during infant stage which begins from the 29th day of life until the age of 3 years;

► during childhood stage which concerns children over 3 years old up to adolescents aged 18 years.

What are the causes of stroke in children?

“In the newborn, half of the causes of stroke remain unknown. It is thought to be due to a problem with the fetal-placental circulation (formation of clots or a problem with the flow that no longer allows the umbilical cord and the placenta to supply the fetus), but we cannot be sure“, explains the neuro-paediatrician. In some cases, the stroke can be the consequence of a congenital heart disease or infection, problems with the placenta, blood clotting disorder or severe dehydration. In babies over 28 days old and children, the stroke may be due to a birth defect, heart problems, blood vessel disorders, infection, blood disease such as leukemia or sickle cell diseasehead trauma…”In all cases, finding the cause makes it possible to direct the care of the child.“, specifies the specialist.

What are the first signs of stroke in children?

After 28 days of life and more the child growsthe more the warning signs of a stroke are almost similar to those of adults:

• weakness or paralysis on one side of the body which appears suddenly, most often on waking;
• suddenly having speech difficulties (speech problems, etc.);
• the fact of having difficulty staying awake and alert outside the hours of siesta and sleep;
• the appearance of seizure disorder or acute headache (very intense, unusual and sudden headache, sudden visual disturbance)

How to recognize stroke in children?

According to an Odoxa survey for the Stroke Research Foundation October 2018, nearly 8 out of 10 French people admit not recognizing the symptoms of stroke in an infant or child. And for good reason, the symptoms of stroke in a newborn or a very young child (under 3 years old) can be very different from those in adults and are often difficult to spot.

Symptoms sometimes different from those of adults.

“The only signs of a perinatal stroke are the appearance of seizure disorders (eye rolling, sudden onset of pallor, repetitive movements (face, sucking, eyes… such as a rapid succession of grimaces, blinking of the eyelids…), fixed gaze, respiratory apnoea…). The smaller the baby, the more an attack on the brain can make it convulse“, explains the neuro-pediatrician. “The baby may not convulse at all and in this case, the stroke of the newborn goes completely unnoticed. It is only after a few months when his motor skills will be refined (4-6 months, but it can be later) that the doctors can notice a weakness on one side of the body, a systematic use of one hand, toes curled on one side only or one of the two fists too often closed. And it’s quite common. While half of newborns with a stroke convulsed at birth, the other half half have no visible signs“adds the specialist.

What to do in case of stroke symptoms in children?

I’very sudden onset certain symptoms (excluding trauma such as a fall or injury) such as inappropriate speech, inability to speak, vision problems (blurred vision, blindness), numbness, inability to move one side of the body, aches very intense headaches, convulsive disorders or a change in alertness can be considered warning signs of a stroke. These symptoms worsen with a few minutes. They can sometimes occur during sleep and can be very marked when the child wakes up. If in doubt, do not wait for these symptoms to persist and react immediately. Call 15 (Samu). “The SAMU regulating doctor will organize the transfer to a neurovascular unit, if the suspicion of stroke is confirmed“, specifies the Foundation for Research on Stroke. And to add “that the symptoms should not be minimized by finding a reassuring explanation for them and that it do not be reassured if the signs subside. Better to call wrong than too late“. Knowing these symptoms helps prevent the risk of brain damage and maximizes the chances of prompt intervention.

What treatments for childhood stroke?

There is no standard treatment for stroke in children, it all depends on the cause, the exact location of the stroke and the sequelae it left. Most often, the child will have to recover his motor and intellectual faculties via a psychomotor rehabilitation (at the hospital, then with liberal specialists such as physiotherapists, speech therapists or occupational therapists…), more or less important and more or less long depending on the type of stroke and the diagnosis that has been made. THE drug treatments (thrombolytic drug) remain very rare in children to treat the sequelae of a stroke. “Because on the one hand, we rarely have the authorizations for the administration of this drug in children under 18 and on the other hand, this drug must be administered within 4h30 following the start of the stroke. However, most children arrive at the emergency room after this time. You should know that the average consultation time for a child for a suspected stroke is 24 to 26 hours after the onset of the first symptom.“, concludes Dr. Bellesme.

Thanks to Dr Céline Bellesme, neuro-pediatrician at CHU Kremlin-Bicêtre.