Arterial ischemic stroke in children often go unrecognized, and the strokes can recur

Children can have strokes, and the strokes can recur, usually within a month, according to pediatric researchers. Unfortunately, the strokes often go unrecognized the first time, and the child does not receive treatment before the recurrence.

Pediatric neurologist Rebecca Ichord, M.D., director of the Pediatric Stroke Program at The Children's Hospital of Philadelphia, reported today on a study of arterial ischemic stroke in children at the International Stroke Conference 2010 in San Antonio, Texas. The conference was sponsored by the American Stroke Association.

An arterial ischemic stroke results from a blockage or constriction in an artery in or leading to the brain.

Ichord and colleagues at Children's Hospital followed 90 children with a median age of about 6 years old, treated for stroke between 2003 and 2009. Twelve patients (13 percent) had a recurrent stroke during the study period, most of them within a month of the first stroke. In six of the 12 children with recurrent strokes, no one diagnosed the initial stroke until a recurrent stroke occurred.

"Strokes don't occur only in the elderly," said Ichord. "They can also affect children as young as infants. Our findings reinforce how important it is to diagnose stroke in children as quickly as possible so that medical caregivers can provide emergency treatment and take measures to prevent recurrence."

Strokes can arise in children as a complication of other illnesses, such as sickle cell disease, which obstructs blood circulation, or from an undetected heart condition. A whiplash injury to a child's neck may damage an artery and leave it vulnerable to a blood clot that causes a stroke. Signs of a stroke are the same as in adults—a sudden loss of neurologic functions such as vision or speech, unsteady gait, or weakness on one side of the face or in limbs. What is different in children, said Ichord, is that symptoms may be subtle, examination is difficult and children are less able to describe their symptoms.

Emergency treatment for a stroke typically involves assuring adequate breathing and circulation, supplying intravenous fluids and improving blood supply to the brain. Medications such as aspirin or blood thinners are given to lower the risk of a recurrent stroke. In the aftermath of a stroke, rehabilitation is critical to promote recovery.

"Because a stroke can recur, we need improved awareness of pediatric stroke among primary health care providers, and more research on the best ways to prevent a recurrence after a child suffers a first stroke," added Ichord.