By Linda Shiue
Delia was a happy, healthy and playful toddler. She did not have any past medical history or chronic illnesses that required monitoring. On a day like any other, she was playing when she slipped on the front steps and fell, hitting her head. Her parents brought her immediately to see her pediatrician, who did a physical exam and reassured them that Delia was fine. Later, Delia's parents noticed that she their daughter was "just a little off." She was drooling a little more than usual, and was clingy. She wanted to be held and carried, rather than walk. These were all behaviors which were not completely unusual, given that she had fallen recently. Understandably worried, despite the reassurance they had received from their pediatrician, Delia's parents took her to see a pediatric neurologist for a second opinion. He also reassured them, and recommended that they bring her to the emergency room if anything worsened. The parents, still convinced that something was wrong, did so, and were shocked to be told that their daughter, their previously healthy two-year-old, had had a stroke.
This is where Heather Fullerton, MD of the University of California, San Francisco, met Delia. Dr. Fullerton, who was a resident at the time, had not heard much about childhood strokes before, and found out that neither have many physicians, including some pediatric neurologists. In Delia's case, the stroke was a complication of the head injury she had the previous day- the carotid arteries in her neck were traumatized by the fall and as a result, blood flow to the brain was interrupted, leading to the stroke.
Indeed, childhood strokes are rare. Even at UCSF, a major referral center in Northern California and where Dr. Fullerton practices, they see about 6 cases per month. There are between 5,000-10,000 cases of childhood stroke per year in the US as a whole. The statistics show that 1 in 4,000 babies will have a stroke, and 1 in 8,300 children will have a stroke.
Fortunately, Delia survived, and after rehabilitation, was able to go back to her normal life.
Her case underscores the importance of identifying a possible stroke early. In addition to maximizing the chances of survival, early treatment maximizes the chances for successful rehabilitation. Without adequate and early rehabilitation, childhood stroke causes multiple disabilities, including paralysis, seizures, speech disorders, behavioral issues, and learning disabilities.
What happened to Delia also highlights the lack of awareness among most parents and even many professionals that children can have strokes. Inspired by Delia and other childhood stroke patients, Dr. Fullerton and colleagues have since created a dedicated pediatric stroke center at UCSF to focus on the research and clinical care of patients like Delia.
What Are the Warning Signs of Strokes in Children?
These are not too different from stroke symptoms in adults. They include
-Not moving one side of the body symmetrically, or weakness on one side
-Having difficulty walking or talking
-Sudden severe headache
-Vomiting, especially together with difficulty walking or sudden severe headache
Image Credit: Bill McConkey, Wellcome Images
May 2010 is Childhood Stroke Awareness Month
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