Stroke in Children

Diksha CheetooRoll No 10

Table of content

IntroductionCauses of stroke in childrenArterial thrombosisEmbolismVenous thrombosis

IntroductionHemiplegia secondary to

vascular disorders occur with and incidence of 1-3/100000 per year.

The pediatric causes of stroke are distinctive from adult causes.

Types of stroke include: Arterial and venous thrombosis,intracranial haemorrhage, arterial embolism and other misc conditions

Causes of stroke in children

Cardiac diseaseCongenitalMitral stenosisVentricular septal defectsPatent ductus arteriosusCyanotic congenital heart

diseaseAcquiredEndocarditisCardiomyopathyAtrial myxoma, arrythmias

Hematologic abnormalities• HemoglobinopathiesSCASCD• Polycythemia• Leukemia/lymphoma• Thrombocytopenia• Thrombocytosis• Disorders of coagulationProtein c def, protein s def

Causes of stroke

Inflammatory disorders• Meningitis ( bact, viral, Tb)• Systemic infectionBacteremea, viremia, head and

neck infections• Drug induced inflammationAmphetamine, cocaine• Autoimmune diseaseSLE,juvenile RA, polyarteritis

nodosum

Metabolic disease associated with stroke

• Homocysteinurea• Pseudoxanthoma elasticum• Fabry disease• Mitochondrial disorders

Causes of stroke in childrenIntracerebral vascular processes• Ruptured aneurysm• Arteriovenous

malformation• Fibromuscular dysplasia• Migraine• Hereditary hemorrhagic

telangectasia• Carotid artery dissection• Post varicella

Trauma and other external causes• Child abuse• Head/neck trauma• Oral trauma• Placental embolism• ECMO therapy

Arterial thrombosis/EmbolismMay involve major

cerebral arteries( the internal carotid or ant, middle and post cerebral artery occlusion) or smaller cerebral arteries

• Thrombosis of the int carotid artery may result form blunt trauma to the post pharynx due to fall on a pencil or popsicle stick in the child’s mouth.

• The injury produces a tear in the intima of the vessel wall and this may lead to the formation of dissecting aneurysm.

• Cerebral symptoms results from shedding of emboli from the thrombus

The onset of symptoms may be delayed for upto 24 hrs after the accident, with a stuttering but progressive flaccid hemiplegia, lethargy and aphasia if the dominant hemisphere is involved.

Focal motor seizures are a common complication

Retropharyngeal abscess

• A retropharyngeal abscess may produce an identical clinical picture but in this case the arterial thronbosis results from inflammation of the intima.

• A cerebral angiogram or MRI or Magnetic resonance Angiography (MRA) typically demonstrate occlusion of the int carotid artery and a CT/MRI shows a hypodense lesion occluding the area of infarction

Embolization• Embolization of cerebral vessels although rare

in children may also produce acute hemiparesis.

• Cardiac abnormalities are the most common overall cause of thromboembolic stroke in children

• Cardiac causes include: arrythmias( particularly atrial fibrillation), myxoma paradoxical emboli through foramen ovale and bacterial endocarditis that results in a mycotic aneurysm

• Air emboli may result from surgery

• Fat emboli results from fracture of long bones

• Septic emboli may seed in the cerebral vessels and evolve in an area of cerebritis and leading to cerebral abscess

Cyanotic congenital heart disease

in children less than 2 yrs may cause thrombosis, particularly in the middle cerebral artery.

These patients are particularly vulnerable when oxygen saturation is significantly decreased together with a viral illness or dehydration

Cardiac procedures including catheter insertion or major cardiac surgeries can result in arterial thrombosis from embolization of clot

Venous thrombosis

Septic causesAseptic causesSymptoms and signs may evolve days and in

neonates are characterised by diffuse neurologic signs and seizures, whereas focal neurological seizures are more prominent in children.

Dilated scalp veins, a prominent bulging ant frontalle and symptoms and signs of raised ICP.

Septic causesInclude encephalitis and bacterial

meningitis mainly.In meningitis there is thrombosis of

superficial cortical and deep penetrating veins.

Other causes include: otitis media and mastoiditis with involvement of dural vessels,

Retrograde orbital infections producing CST

AAseptic causes

Severe dehydration in infancyThrombosis of superficial sagital sinus and

superficial cortical veins due to hyperviscosity and slugging of blood

Other causes : hypercoagulopathies, cyanotic congenital heart diseases, leukemia, deficiencies of inh of coagulation( protein c, s,antithrombin c,)