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Strokes in Children

Stroke denotes the sudden onset of a focal neurologic deficit and most often includes the abrupt appearance of weakness. Interruption of blood flow to a part of the central nervous system (CNS) usually underlies the resultant weakness. Because most strokes in children are related to focal cerebral involvement, the most common clinical manifestation is the abrupt appearance of hemiparesis. Less frequently, the cause of stroke involves the brain stem, cerebellum, or spinal cord. The functional consequences always reflect the neuroanatomic features of the affected CNS region.

Epidemiology

Childhood stroke occurs with an annual incidence of 2.5 cases per 100,000 population and has been reported in all racial and ethnic groups. The sequelae are not trivial. In addition to lasting lateralized weakness, cognitive deficits, disturbances of language, visual deficits, and seizures may persist long after the acute event has concluded.

The causes of stroke in children differ from those in adults. Stroke in adults is associated largely with hypertension or atherosclerosis and their respective hemorrhagic and ischemic consequences. Stroke in children more commonly is caused by or related to congenital heart disease, infection, metabolic disorders, hematologic diatheses, and vasculitic disorders, frequently due to autoimmune processes (Table 1). Nonetheless, despite the most thorough of evaluations, etiology escapes detection in approximately 30% of the pediatric patients in whom stroke occurs.

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