Paediatric strokes are relatively uncommon but are still a significant concern due to their potential long-term impacts on a child’s development.
In children, the most common causes include congenital heart defects, sickle cell disease, infections such as meningitis, and trauma to the head or neck.
Unlike adult strokes, which are largely caused by lifestyle-related factors, paediatric strokes are often linked to pre-existing health conditions and infections. These differences make diagnosing and preventing strokes in children more complex than in adults.
Prevalence of paediatric strokes in Southern Africa
Socio-economic factors, healthcare access, and genetic predispositions also play a role in regional disparities across the country.
Paul Lee, an assistant professor of Biomedical Engineering has researched sickle cell disease and strokes in children. He has found that there are about 300,000 babies born every year with sickle cell disease, an inherited red blood cell disorder, living in sub-Saharan African countries.
Sickle cell disease can cause a lower oxygen level and abnormal blood flow in the brain, which is associated with a high risk of stroke. Without treatment, 11% of children with sickle cell disease will have a stroke before they turn 20 years old.
Early signs and symptoms of a stroke in children
Recognising a stroke in children can be challenging because the symptoms are often subtle or mistaken for other conditions.
“The symptoms of a stroke in young people are similar to those in older adults,” says Dr Themba Hadebe, Clinical Executive from Bonitas Medical Fund.
He goes on to say that the early signs and symptoms of a stroke in children may include sudden severe headaches, difficulty speaking or understanding speech, seizures or dizziness, problems walking or even nausea and vomiting.
In the youngest stroke patients, congenital heart abnormalities or heart valve problems that lead to clot formation can cause a stroke.
Risk factors and prevention
Dr Hadebe says: “Heart diseases and blood clotting diseases mostly cause strokes in children. Paediatric strokes present in statistically significant numbers amongst children, and due to the ever-increasing sedentary lifestyle of children and adolescents, this number is unfortunately on the rise.”
While some risk factors, such as congenital issues, cannot be prevented, managing conditions like sickle cell disease and infections is essential.
Vaccinating against infections like meningitis is an important preventive measure. Systemic diseases such as chickenpox have also been related to strokes in children.
Types of strokes
Dr Hadebe, explains the two types of strokes. “There are two main causes of strokes;- ischemic, caused by a blocked artery in the brain and haemorrhagic. Around 12% of patients may experience a temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA) or mini-stroke around three months before a full-blown stroke”.
Hadebe says; “TIAs may cause symptoms similar to an intense migraine when a clot temporarily blocks a blood vessel but gets dislodged.
“A silent stroke, caused by a clot that blocks a blood vessel in the brain, prevents blood and oxygen from reaching that area, resulting in brain cells dying. Depending on the location of the clot, sometimes, the area of damage is small and occurs in a part of the brain that doesn’t control any vital functions, so the stroke remains undetected.”
Diagnosis challenges in paediatric strokes
Diagnosing strokes in children presents unique challenges. In adults, stroke diagnosis often relies on recognising typical symptoms like facial drooping, slurred speech, and arm weakness.
However, children may not display these classic signs, and younger children may be unable to communicate their symptoms. Medical professionals must rely on imaging technologies like MRI and CT scans, alongside clinical assessments, to confirm a stroke in a child. Misdiagnosis or delayed diagnosis is a significant concern, especially in rural areas of South Africa where access to advanced medical care may be limited.
Treatment options and effectiveness
Regarding treatment of the strokes, Dr Hadebe says: “The treatment of the stroke is primarily dependent on the cause. If the stroke was caused by a blood clot, blood thinners are given to dissolve that blood clot. At times, surgery may be indicated depending on the size and position of the clot.
“Treatment can be very effective, but treatment must be initiated as soon as possible (2 to 6 hours) after the onset of the incident.”
Surgery may be required in cases of haemorrhagic stroke, where bleeding in the brain needs to be controlled.
Long-term impacts of strokes on children
The long-term effects of paediatric strokes can be profound, affecting both cognitive and physical development.
Many children face challenges with learning disabilities, speech impairments, and physical mobility. The earlier the intervention and rehabilitation start, the better the outcomes tend to be.
However, children who suffer severe strokes may experience lifelong disabilities, including paralysis or difficulty with basic functions. Emotional and psychological support is also crucial, as strokes can significantly impact a child’s mental health and social development.
While paediatric strokes are less common than adult strokes, they present significant challenges in terms of diagnosis, treatment, and long-term care, including physiotherapy, speech therapy, and occupational therapy, are critical for recovery.
Hadebe stresses that awareness around strokes in children is not as common as adults and therefore there needs to be a greater focus on awareness regarding “young strokes”.
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