Stroke in Children : Sydney Cognitive Development centre

What is a stroke?
A stroke is a sudden disruption to the blood supply
of the brain. It affects neurological functions - that
is, functions which are controlled by the brain, such
as movement and speech.

There are two major types of stroke:

ischaemic: this is caused by a blockage of the blood
supply to an area of the brain

haemorrhagic: this is caused by blood leaking from
blood vessels into the brain

Both types of stroke cause damage to brain cells.
The resulting difficulties experienced by the child
depend on the area of the brain which is affected.

What causes strokes in children?
About half of all affected children have an
underlying medical condition - for example, sickle
cell anaemia or a heart problem - which increases
their chance of having a stroke.

The other half are apparently healthy beforehand.
There are many possible causes of stroke in this
group of children. One of the commonest is a
narrowing of the blood vessels within the head as a
result of the chickenpox virus. This is a rare effect of
chickenpox and it is not known why some children
develop this complication. Other causes of
childhood strokes include other abnormalities in the
blood vessels supplying the brain or an increased
tendency for the blood to form clots.

In around 10% of children who have a stroke, no
cause is identified despite extensive tests.

The causes of strokes in children are not the same
as in adults. Adult strokes are often brought on by
smoking, high blood pressure or "furring up" of the
arteries.

What are the signs that a child has had a
stroke?
This depends on the area of the brain which has
been affected by the stroke. As with adults, the most
common effect of strokes in children is weakness
down one side of the body. In a toddler this may be
relatively difficult to recognise. It may appear that he
or she is having difficulty with balance. A child’s face
may droop on one side and his or her speech may
be affected. Some strokes affect the areas of the
brain responsible for balance and co-ordination.

Is it painful for the child?
Older children often complain of headache at the
time of a stroke. Apart from this there is usually no
pain. Sometimes in the days after a stroke, children
may experience cramps, particularly in their affected
hand or foot.

Can strokes be hereditary?
The causes of strokes in children and adults are
very different and so the fact that older members of
the family might have had strokes is not usually
relevant. In some cases, blood clotting or chemical
problems which can run in families may cause
strokes; we will usually look for these in children who
have had a stroke.

How well do children recover from strokes?
Although it is commonly believed that, in contrast to
adults, children recover fully after strokes, it is
probably more accurate to say that children recover
differently from adults. Strokes can affect many
aspects of a child’s functioning, including cognitive
abilities, movement, speech, behaviour and
learning. However, the good news is that in the
majority of cases these effects are mild.
Improvements in many of these areas may continue
to be seen for several months after the initial stroke.

Speech and language problems improve most
rapidly over the first year. Both language (if
affected) and learning should be formally assessed
as it may be hard to pick up difficulties in these
areas. Sometimes a child’s behaviour is affected by
a stroke. This depends partly on the area of the
brain affected but problems may include difficulties
with attention and concentration.

What can be done to improve recovery?

At the Sydney Cognitive Development Centre we
assess, follow and treat the cognitive, behavioural,
language, emotional, social and attention problems
that may occur after stroke. Occupational therapy,
physiotherapy and/or speech and language therapy
can also help with rehabilitation after a stroke.
Therapy usually begins as soon as possible
following the stroke. Therapy aims to make daily
activities easier for the affected child. We will
suggest ideas for home and school to develop skills
and minimise any cognitive, social, emotional or
behavioural problems.

No two children recover in the same way after a
stroke. Their progress depends on many factors
including which part of the brain is affected, the
cause of the stroke and any other difficulties they
may have. The rehabilitation process helps the child
to develop his or her abilities to live as normal a life
as possible. This is important in developing self-
esteem and building confidence. It may be helpful to
have access to our therapy services for support and
advice if any questions or difficulties arise in the
months or years after the stroke.