New Stroke Guidelines for Children

By Stephanie Watson
WebMD Health News Reviewed by Louise Chang, MD

July 17, 2008 -- Strokes don't only occur in older adults -- children can have them too. Because stroke can lead to brain damage and death, the American Heart Association/American Stroke Association has for the first time released guidelines on diagnosing and treating stroke in children.

"Stroke in children is uncommon but not as rare as we used to think," E. Steve Roach, MD, chair of the statement writing group and professor of pediatric neurology at the Ohio State University College of Medicine, says in a news release. About 10 out of every 100,000 children have a stroke each year. The risk is greatest during the first two months of life.

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Children tend to have a different kind of stroke than adults. About 80% of adult stroke victims have an ischemic stroke, in which a blockage in a blood vessel cuts off blood supply to the brain. Only about 55% of strokes in children are ischemic. The rest are hemorrhagic, meaning there is bleeding in the brain.

Risks for stroke also differ between children and adults. Most adults with stroke have a history of risk factors such as high blood pressure, cigarette smoking, or artery disease, which they can work to control. In children the most common causes are sickle cell disease and heart disease. Often a stroke is the first warning sign of these diseases. "That's why it's critical to promptly recognize and diagnose a stroke, because treating the cause reduces the likelihood of additional strokes," Roach says.

The first step in diagnosis is to identify the symptoms, which in children can be atypical. "In newborns, the first symptom is often seizures of an arm or leg," Roach says. "Seizure is a much less common stroke symptom in adults."

Doctors have gotten much better at diagnosing stroke in children, thanks to modern imaging technologies such as magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and computed tomography (CT) scans. Each test has its pros and cons, and which one doctors use will depend on the child's situation, the authors write in the guidelines, which were published in Stroke: Journal of the American Heart Association.

Once a child has been diagnosed, treatment is aimed at preventing both neurological damage and future strokes.

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