Strokes In Children, February 17, 2006

Who would think a seemingly healthy teenager would suffer a stroke? Certainly not 13-year-old Colin Quinn, of Exton, Pa., who suddenly found he couldn't get into the family car as he was leaving a guitar lesson. Colin was unable to move the left side of his body.

Fortunately, Colin's parents acted quickly, calling an ambulance and having him taken to a pediatric hospital that was prepared to assess and treat this sudden event. The medical staff diagnosed it as a stroke--an interruption in blood flow within the brain. Today, two years later, Colin still has lingering weakness in his left arm and other aftereffects, but has largely recovered.

"Although usually thought of as afflicting only elderly patients, strokes may occur as early as infancy," said pediatric neurologist Rebecca Ichord, M.D., who treated Colin at The Children's Hospital of Philadelphia. "Stroke needs to be considered by first-line pediatric caregivers who encounter a patient with suspicious neurological symptoms, such as difficulty walking or using an arm."

"Emergency medicine staff members are far more aware of the possibility of stroke among adult patients than they are among children who are brought to the hospital," added Dr. Ichord, who directs the Pediatric Stroke Program at Children's Hospital.

Dr. Ichord led a study featured at the "Children and Stroke" news conference today at the International Stroke Conference sponsored by the American Stroke Association. Her study team found that delays were common in diagnosing stroke in children, and proposed that improved knowledge and management of stroke symptoms could lead to improved outcomes.

Dr. Ichord and colleagues from Children's Hospital and the University of Pennsylvania School of Medicine explained results of a study of 12 children aged 2 to 18 years old, who presented to various local emergency centers in 2003 and 2004. All the children had acute arterial ischemic stroke, with the main symptoms either one-sided paralysis or difficulty walking normally. Although the majority of children in the study were brought to medical attention promptly after the onset of their symptoms, they experienced delays approaching 24 hours before receiving a definitive diagnosis and emergency stroke-specific treatment.

"The faster we can recognize and diagnose stroke, the more quickly we can apply effective treatment," said Dr. Ichord. "The first treatment involves neuroprotective measures, which include maintaining adequate blood pressure, and supplying fluids and appropriate medication. Later, the patient may need aggressive physical rehabilitation."

Strokes in children may occur as complications of other illnesses, such as sickle cell disease, in which misshapen blood cells obstruct circulation. Another cause of stroke may be a whiplash injury to the neck, which damages an artery, and leaves it a vulnerable site for blood clots.

Colin Quinn's stroke may have been related to a previously undetected heart condition, but whatever the cause, the prompt recognition and treatment of his symptoms apparently contributed greatly to his recovery. Dr. Ichord will be working with other pediatric medical centers to broaden awareness of pediatric stroke. "We will be researching a clinical assessment tool used to assess strokes in adults, and adapting and evaluating it for use in children," she added.