Childhood Stroke & Neurovascular disorders
Recognising stroke and neurovascular disorders in children is crucial for identifying symptoms early and ensuring prompt intervention. Although these conditions are commonly associated with adults, they can also impact children, resulting in significant health issues. By increasing their knowledge about strokes and neurovascular disorders in children, parents and caregivers can be better prepared to recognise warning signs and seek appropriate medical care.
A stroke in children occurs when blood flow to the brain is interrupted, depriving it of oxygen and essential nutrients. This interruption can be caused by a blockage in a blood vessel, known as an ischaemic stroke, or by the rupture of a blood vessel, referred to as a haemorrhagic stroke.
Neurovascular disorders include a range of conditions that affect the blood vessels and blood flow within the brain and the central nervous system. These conditions may involve aneurysms, arteriovenous malformations (AVMs), and other abnormalities that disrupt normal blood circulation and increase the risk of stroke. Although these disorders are less common in children compared to adults, they can still have serious consequences and require immediate medical attention.
Types of Neurovascular Disorders in Children
In children, neurovascular disorders encompass various conditions that can have serious implications for their health. Here are some types:
Ischemic Stroke
This occurs when a blood clot blocks an artery, cutting off blood supply to a part of the brain. It’s the most common type of stroke in both adults and children.
Hemorrhagic Stroke
This type of stroke involves bleeding into the brain due to the rupture of a blood vessel. Hemorrhagic strokes are less common in children but can be life-threatening.
Arteriovenous Malformations (AVMs)
AVMs are abnormal tangles of blood vessels in the brain that disrupt normal blood flow and increase the risk of bleeding or stroke. They can be present at birth and may cause symptoms if they rupture or grow larger.
Moyamoya Disease
Moyamoya disease is a rare condition characterised by the narrowing or blockage of the blood vessels in the brain, leading to reduced blood flow. It can cause strokes and other neurological symptoms, particularly in children.
Other Rare Neurovascular Conditions
Various other rare neurovascular conditions can affect children, including cerebral aneurysms, cavernous malformations, Takayasu arteritis, Vein of Galen Malformations and other venous malformations. These conditions may require specialised care and treatment.
What Are the Causes and Risk Factors for Stroke and Neurovascular Disorders in Children?
Stroke and neurovascular disorders in children can have various causes and risk factors that contribute to their development. Here are some common ones:
Congenital Heart Disease
Children born with congenital heart defects may have an increased risk of stroke due to abnormalities in blood flow or the formation of blood clots within the heart.
Blood Clotting Disorders
Conditions that affect blood clotting, such as thrombophilia or sickle cell disease, can predispose children to ischaemic stroke by promoting the formation of blood clots within blood vessels.
Traumatic Brain Injury
Head trauma or traumatic brain injury (TBI) can damage blood vessels in the brain and increase the risk of hemorrhagic stroke or other neurovascular complications.
Genetic Predisposition
Certain genetic factors or familial predispositions may increase a child’s susceptibility to stroke or neurovascular disorders. For example, RNF213 gene is related to familial moyamoya disease, and RASA1 mutation is associated with Capillary Malformation-Arteriovenous Malformation (CM-AVM). .
Infections and Inflammatory Conditions
Infections such as meningitis or encephalitis can cause inflammation of the blood vessels in the brain, leading to vasculitis and an increased risk of stroke. Inflammatory conditions like Systemic Lupus Erythematosus (SLE) or Kawasaki disease can also affect blood vessel health and function, predisposing children to neurovascular complications.
What Are the Signs and Symptoms of Stroke and Neurovascular Disorders in Children?
Recognising the signs and symptoms of stroke and neurovascular disorders in children is crucial for prompt medical attention and intervention. Here are common indicators to watch for:
Sudden Weakness or Numbness
Sudden weakness or numbness, especially on one side of the body, can be a sign of stroke. Children may have difficulty moving an arm or leg, or they may complain of tingling sensations.
Difficulty Speaking or Understanding
Children experiencing a stroke may have trouble speaking or understanding language. They may slur their words, have difficulty finding the right words, or struggle to comprehend spoken or written language.
Severe Headache
A sudden and severe headache, especially if it’s accompanied by vomiting, dizziness, or changes in consciousness, can be a warning sign of a stroke or other neurovascular disorder.
Vision Changes
Sudden changes in vision, such as blurry vision, double vision, or loss of vision in one eye, may indicate a problem with blood flow to the brain or optic nerve.
Dizziness or Loss of Balance
Children experiencing a stroke may feel dizzy or unsteady on their feet. They may have difficulty maintaining their balance or coordination.
Seizures
Seizures, especially if they occur suddenly and without a known cause, maybe a symptom of a neurovascular disorder. Seizures can manifest as convulsions, twitching, or staring spells.
Changes in Behaviour or Personality
Neurovascular disorders can sometimes cause changes in behaviour or personality. Children may become irritable, agitated, or withdrawn, or they may experience sudden mood swings or emotional outbursts.
Loss of Consciousness or Altered Level of Consciousness
In severe cases, a child experiencing a stroke or other neurovascular event may lose consciousness. This is a medical emergency and requires immediate medical attention.
What Are The Common Co-Occurring Conditions?
Children with stroke and neurovascular disorders may experience co-occurring conditions that can impact their overall health and well-being. Some common co-occurring conditions include:
Epilepsy
Children who have experienced a stroke or have certain neurovascular conditions may be at increased risk of developing epilepsy. Epileptic seizures can vary in type and severity and may require treatment with anti-seizure medications.
Developmental Delay or Learning Disabilities
Stroke and neurovascular disorders can disrupt normal brain development, leading to developmental delay or learning disabilities in affected children. These may involve motor skills, language development, cognitive function, or social-emotional development.
Cerebral Palsy and Motor Impairments
Stroke and neurovascular disorders can lead to motor impairments such as weakness, paralysis, spasticity, or coordination difficulties. These motor impairments may affect mobility, self-care skills, and participation in daily activities.
Some children who experience a stroke or have certain neurovascular conditions may develop Cerebral Palsy (CP), a group of movement disorders that affect muscle coordination and posture. CP can result in motor impairments, speech difficulties, and other challenges.
Cognitive Impairments
Children with stroke or neurovascular disorders may experience cognitive impairments, including difficulties with memory, attention, executive function, and problem-solving. These cognitive deficits can impact academic performance and daily functioning.
Behavioural and Emotional Challenges
Living with a chronic health condition like stroke or a neurovascular disorder can contribute to behavioural and emotional challenges in children. They may experience anxiety, depression, mood swings, or behavioural problems that require intervention and support.
Speech and Language Disorders
Children with stroke or neurovascular disorders may experience speech and language disorders, including difficulties with articulation, fluency, or comprehension. Speech therapy may be necessary to improve communication skills.
Visual Impairments
Neurovascular conditions affecting the brain or optic nerves can lead to visual impairments such as blindness, visual field deficits, or difficulty with visual processing.
Psychosocial Challenges
Coping with the effects of stroke or a neurovascular disorder can impact a child’s psychosocial well-being, including self-esteem, social relationships, and overall quality of life. Psychosocial support and counselling may be beneficial for addressing these challenges.
How Are Stroke and Neurovascular Disorders in Children in Kids Diagnosed?
Diagnosing stroke and neurovascular disorders in children involves a comprehensive evaluation by paediatric neurologist, including a detailed medical history, physical examination, neurological assessment, and imaging studies such as MRI or CT scans. Laboratory tests may be conducted to assess for underlying medical conditions, while genetic testing may be recommended in cases of suspected genetic predisposition.
Collaboration with specialists from various disciplines, including paediatric neurology, neurosurgery, and rehabilitation, is essential for a thorough evaluation and management plan. Early detection and intervention are critical for optimising outcomes and providing appropriate treatment and support for affected children and their families.
What Are The Treatment Options For Stroke and Neurovascular Disorders in Children?
Treatment options for stroke and neurovascular disorders in children aim to manage symptoms, prevent complications, and improve long-term outcomes. Here are common approaches:
Medications
Medications may be prescribed to manage symptoms and prevent complications. For example, anticoagulants or antiplatelet agents may be used to prevent blood clots, while anti-seizure medications may help control seizures.
Rehabilitation Therapy
Rehabilitation therapy, including physical therapy, occupational therapy, speech therapy, and orthotist plays a crucial role in helping children recover and regain function after a stroke or neurovascular event. These therapies improve mobility, motor skills, communication, and daily living activities; Appropriate equipments or aids, and orthotic devices can be useful in improving mobility and posture.
Surgery
In some cases, surgical interventions may be necessary to address underlying vascular abnormalities or to prevent recurrent strokes. Procedures such as endovascular therapy, surgical revascularisation (e.g. bypass surgery), or embolisation may be performed to treat arteriovenous malformations (AVMs), aneurysms, or other vascular lesions.
Interventional Radiology
Interventional radiology techniques, such as embolisation or thrombectomy, may treat acute stroke or manage vascular abnormalities by blocking or removing blood clots or abnormal vessels.
Supportive Care
Supportive care measures, including close monitoring, hydration, nutrition support, and management of other medical conditions, are essential for optimising outcomes and preventing complications in children with stroke or neurovascular disorders.
Long-Term Follow-Up
Long-term follow-up with paediatric neurologist and allied healthcare providers are essential to monitor the child’s progress, adjust treatment as needed, and address any new or ongoing concerns. Regular evaluations may include imaging studies, neurological assessments, and developmental screenings may be used to track the child’s recovery and outcome measures.
If you have any further questions, you can schedule an appointment today with Dr Yeo.
References
Dr Yeo’s recent peer-group review journal publications and abstracts regarding Stroke and Neuromuscular disorders:
Tho-Calvi SC, Thompson D, Saunders D, Agrawal S, Basu A, Chitre M, Chow G, Gibbon F, Hart A, Tallur KK, Kirkham F, Kneen R, McCullagh H, Mewasingh L, Vassallo G, Vijayakumar K, Wraige E, Yeo TH, Ganesan V. Clinical features, course and outcomes of a UK cohort of pediatric moyamoya.
Neurology. 2018 Feb 27;90(9):e763-e770.
Babiker M, Yeo TH, et al A Venous Malformation Presenting as Toe-walking. Pediatric Neurology. Jan 2015; 52(1):133-134.
I McArthur, TH Yeo, J Bhattacharya. Developmental Outcomes in Children treated for Vein of Galen Malformation (VGAM). Eur J Paediatr Neurol. 2015 May:19(1):47.
S Joseph, TH Yeo, J Bhattacharya. Case series of late presenting Vein of Galen Aneurysmal Malformation (VGAM): clinical features, angiographical features, interventions and outcomes. Eur J Paediatr Neurol. 2015 May:19(1):46-47.
S Joseph, TH Yeo. A case of unusual lower limb movement disorder in association with Klippel-Trenaunay syndrome (KTS). Eur J Paediatr Neurol. 2013 Sept;17(1):202.
