Infants and Stroke: A Very Real Concern

They're as common in newborns as they are in the elderly

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By
HealthDay Reporter

TUESDAY, Jan. 21, 2003 (HealthDayNews) -- When you think of childhood ailments, chicken pox and ear infections might come to mind.

Now you can add stroke to the list.

Neurologists say strokes are as common in newborns as they are in the elderly. In older children, strokes are far rarer, but they do occur.

Surprised?

You're not alone. Neurologists say many parents and even pediatricians are unaware of the risk of stroke in the very young. As a result, strokes in newborns and children are often missed, says Dr. Donna Ferriero, chief of neurology at the University of California, San Francisco.

Strokes are diagnosed late or not at all, little is known about how to prevent strokes, and there are few well-accepted treatments for strokes in the very young, she says.

"There are two peaks of incidence of stroke, in infancy and old age," Ferriero says. "Stroke in newborns is as big a problem as it is in the elderly. It's very, very common."

An analysis of a national hospital database found four in 1,000 newborns had a stroke. Newborn is defined as the period during gestation to 30 days old, Ferriero says.

Strokes in older children are much less common. About seven in 100,000 children had a stroke, according to the analysis, which was published recently in the journal Neurology.

Still, parents and physicians need to be aware strokes can occur.

The symptoms of stroke in children and adults are similar, says Dr. Deborah Hirtz, a pediatric neurologist and program director for the National Institute of Neurological Disorders and Stroke.

A child may suddenly start to favor one side of the body, or one hand. If a child does this from birth, it may indicate a stroke that was missed earlier, Hirtz says.

"When an adult has a sudden onset of difficulty forming words, a sudden onset of a weakness in an arm or leg or one side of the body, or sudden difficulty with balance and coordination, people tend to think of stroke," says Hirtz, who is chairwoman of child neurology at the American Academy of Neurology. "But when it happens to children, people don't think of stroke. They think it will go away. There's a much lower awareness that a stroke can happen to a child."

In infants, strokes are harder to spot because the very young lack muscle coordination anyway, Hirtz says. An MRI scan can reveal the damage to the brain and confirm a stroke.

"If a parent has a 5-month-old who's only using one hand to hold the bottle, there's a problem and they need to come in and have an MRI," Ferrerio says.

The causes of stroke in infancy and childhood are largely unknown. Research suggests many factors probably contribute, including infections, birth defects, blood-clotting disorders and birth trauma, Ferriero says.

Ferriero and her colleagues reviewed medical records of 30 pairs of mothers and babies who had a stroke. Researchers found 18 of the babies had risk factors that included blood-clotting disorders, problems during the pregnancy such as infections, fevers or a difficult birth.

Researchers were able to test the blood samples of seven of the babies who had strokes. Four had a genetic blood-clotting disorder.

"Our hypothesis is that multiple risk factors set a neonate up to have a stroke," Ferriero says.

Researchers hope that studying the causes of stroke in newborns may reveal clues about some of the genetic underpinnings of strokes in adults.

"We think that if we could figure out the risk factors for stroke in the newborn, we could help adults," Ferriero says.

What is known is that strokes can be devastating at any age. Strokes in infants are a common cause of cerebral palsy, a neurological disease that's marked by severe abnormalities in movement and muscle weakness.

And children who've had a stroke are susceptible to having another one. About 6 percent of children who have a stroke die, about 25 percent of children have another stroke and about two-thirds have lasting neurological problems or seizures, according to the study.

The good news is that children's brains are very "plastic," meaning they have a great capacity to learn to compensate for the damage.

That's why it's so critical to diagnose the stroke early. The sooner children begin physical, occupational or speech therapy, the better the chance they have at adapting, Ferriero says.

More information

To read more about childhood stroke, visit the Pediatric Stroke Network, the Children's Hemiplegia and Stroke Association, or the National Institute of Neurological Disorders and Stroke.

SOURCES: Donna Ferriero, M.D., chief neurologist, University of California, San Francisco Department of Neurology; Deborah Hirtz, M.D., pediatric neurologist and program director, clinical trials, National Institute of Neurological Disorders and Stroke, Bethesda, Md.

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