Even Infants Can Suffer Strokes

The brain attacks strike seemingly healthy babies, experts say

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HealthDay Reporter

FRIDAY, June 24, 2005 (HealthDay News) -- Parents of newborns often worry their babies may choke, or not feed well, or perhaps struggle with breathing problems.

Few consider the possibility their child may suffer a stroke.

But they need to be aware of that risk, 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.

"Most people are under the impression that babies and children don't have strokes. Part of what makes it surprising is that it can certainly happen in otherwise healthy babies," said Dr. Heather Fullerton, an assistant professor of pediatrics and neurology at the University of California, San Francisco, who has published research on the topic.

Experts are still trying to determine why strokes occur in the very young. Complicating matters, strokes in infants are often diagnosed late or not at all. And there are few well-accepted treatments for these little patients.

But children's brains are very "plastic," which means they have a great capacity to learn to compensate for the damage, experts say.

About one in 4,000 or 5,000 infants suffers a stroke sometime in the first month of life, according to Dr. John Kylan Lynch, a researcher at the National Institute of Neurological Disorders and Stroke.

"From age one month to 18 years, the rate is about 1 or 2 per 30,000," Lynch added.

About half of infant strokes are ischemic, which means a brain artery has become blocked. The other half are hemorrhagic, in which a blood vessel has burst, Fullerton said.

According to Lynch's research, up to 12 percent of newborns who suffer a stroke will die. Few newborns have a repeat stroke, he said. "The recurrence rate is up to 5 percent, although recent studies suggest rates less than 1 percent," Lynch said.

While strokes in infants often strike suddenly, there can sometimes be warning signs. "In infants, it could be seizures or sudden onset of weakness on one side of the body and usually involves the hands," Fullerton said. "Certainly if parents see an acute change like that, they should go to the emergency department."

Once there, the infant can be taken to the neonatal intensive care unit and a CT scan of the head performed, to rule in or out a stroke.

In his research, Lynch has found that black infants are twice as likely as white children to suffer a stroke. Part of that increased risk owes to the prevalence of sickle cell disease, an inherited disorder of the red blood cells. "Sickle cells over time damage the blood vessels to the brain," he said.

Infants who suffer stroke are often basically healthy babies, Lynch noted. So what goes wrong? "We don't really know. What we are finding is that many of these mothers have pregnancy complications, such as preeclampsia [in which the pregnant woman's blood pressure rises to abnormal levels] or maybe an infection during pregnancy," he said.

"Many of the mothers turn out to have blood clotting abnormalities, and somehow it is passed on to the baby," he added.

Sometimes, doctors can't determine exactly when the stroke occurred in a newborn. "A stroke around the newborn period can occur before the child is born, when coming down the birth canal or after the child is born," Lynch said.

While there is no specific treatment for newborn stroke, doctors recommend that if there is a fever, it be controlled and that infection be ruled out, since it can trigger a stroke, Lynch said. Seizures must be controlled, too.

There have been some pilot studies in adults that have shown cooling the body may protect the brain. A cooling cap may help in children, but that is yet to be proven, Lynch pointed out.

Parents shouldn't blame themselves if they don't recognize the warning signs of a stroke in their newborn, Lynch stressed. "Probably 30 percent go unrecognized" when they first occur, he said.

Part of the problem is that a baby can't tell a parent he or she has lost feeling in a hand, for instance. And their muscle coordination is just developing, so it's difficult to determine if there is muscle weakness.

The good news: "In general, children recover better than adults from stroke," Fullerton said. They may need extra help by the time they reach school age. And teachers should be told about their medical history, she advised.

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, Fullerton said.

More information

To learn more, visit the Children's Hemiplegia and Stroke Association.

SOURCES: John Kylan Lynch, D.O., M.P.H., researcher, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md., and medical advisor for the Children's Hemiplegia and Stroke Association and the Pediatric Stroke Network; Heather Fullerton, M.D., assistant professor of pediatrics and neurology, University of California, San Francisco

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