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Stroke in children: know the signs

Prof M Karim Khan
Few days back at around 9 pm, one anxious mother called me for an urgent consultation for her four year old son Rafi (name disguised to protect identity). The boy was continuously crying and suddenly, he was unable to move his right hand and leg. His face was drawn to left side and he could not speak as well. All that happened in a couple of hours. I tried to make her calm and advised her to bring her son immediately to my office.
I took detail history from mother and found that Rafi had been suffering from unusual headache, mild respiratory tract infection and occasional vomiting for last three days. He did not have any significant problem since birth. He was a breastfed baby, immunised as per EPI schedule and attained all developmental milestones in time. On examination, I found the child having right sided weakness with facial paralysis that reflected a problem in left side of his brain. My initial working diagnosis was Paediatric Stroke Syndrome. Then I advised a CT scan of the brain to exclude a fatal type of stroke due to bleeding into the brain.
I advised to admit Rafi in the Paediatrics Department of Community Based Medical College Hospital and subsequently managed his condition as ischemic stroke (occurs when blood vessel to the brain is occluded leading brain area damage). The boy showed some improvement in face the following morning which was a good sign.
I tried to explore the cause
behind stroke with some investigations and took the help of physiotherapist to improve his weakness further. His condition was improving gradually and after seven days, Rafi got reasonably well and started walking with some unstable gait, speaking relatively good and playing with mother. We discharged the child with advice and schedule for follow up. After two weeks follow up, I found Rafi
recovered almost completely from his serious illness to bringing smile to his mother.
Like Rafi, stroke in infant and children is not very uncommon. Contrary to popular belief, the risk for a stroke in a newborn is as high as it is in the elderly. In fact, it is one of the top 10 causes of death worldwide. But, recognition of stroke in children is often delayed or even missed in most children. Many children
with stroke symptoms are misdiagnosed with more common conditions that mimic stroke, such as migraines, epilepsy or viral illnesses.
In most stroke in newborn, a cause cannot be found. In children, it may be secondary due to sickle cell anemia (when there is production of abnormal red blood cell and destruction), congenital heart disease, clotting problem, narrow blood vessels, inflammation of vessels, rheumatic heart disease, head injury, intracranial bleeding etc.
Stroke in infant is usually manifest as seizure/convulsion specially in one side of body and in older children as weakness, numbness, severe headache, aphasia, vomiting, trouble in walking, loss of coordination, paralysis in one side etc.
Early recognition and treatment during the first hours and days after a stroke is critical in optimising long-term functional outcomes and minimising recurrence risk. Take care of your sweet kids.
The writer is a Paediatrician working at Community Based Medical College (CBMC), Mymensingh.
E-mail: mmukkhan@gmail.com