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What are the signs of stroke in children?

Every year, 1,000 children and infants suffer a stroke. The rarity of pediatric stroke largely explains the fact that it is unknown. How to prevent them? What are the symptoms? Answers of Dr. Céline Bellesme, neuro-pediatrician.
If strokes are primarily adults (this is the third cause of death after cancer and myocardial infarction in people over 18), these strokes affect, admittedly more rarely, the children. In fact, about 1,000 children and infants in its victims each year. If few children die (about 10%), this pathology is today the first cause of acquired handicap of the child, recalls the Foundation.

How to recognize the signs of stroke in children?

First, be aware that pediatric stroke can occur:
during the perinatal stage: this is known as fetal stroke, before birth (in practice, fetal stroke occurs during the third trimester of pregnancy), and neonatal stroke, from birth to 28 days after birth.e "Of the 1,000 children with stroke each year, half are newborns younger than 28 days," says Dr. Céline Bellesme, neuro-pediatrician at Kremlin-Bicêtre University Hospital:
·       During the infant stage which begins on the 29th day of life until the age of 3.
·       During the childhood stage, which concerns children over 3 years of age to adolescents aged 18 years.
According to the results of an Odoxa survey for the Foundation for Stroke Research unveiled on October 29, 2018, on the occasion of World Stroke Day, nearly 8 in 10 people admit they do not recognize the symptoms of stroke. Stroke in an infant or child. And for good reason, the symptoms of stroke in a newborn or very young child (under 3 years) can be very different from those in adults and are often difficult to spot. 
The only signs of a perinatal stroke are the appearance of convulsive disorders (eye revulsion, abrupt access to pallor, repetitive movements (face, suction, eyes ... like a quick succession of grimaces, blinking eyes ... The more the baby is small, the more aggression of the brain can convulse it, "explains the neuro-pediatrician. 
The baby may not convulse at all and in this case, the stroke of the newborn goes completely unnoticed. It is only after a few months when its motricity will be refined (4-6 months, but it may be later) that doctors may notice a weakness on one side of the body, a systematic use of one hand, toes curled up on one side or one of the fists too often closed.
 Although half of the newborns who have had a stroke convulsed at birth, the other half did not show any visible signs, "adds the specialist.
After 28 days of life and as the child grows older, the warning signs of a stroke are almost like those of the adult:
·       weakness or paralysis on one side of the body that appears suddenly, most often on awakening
·       Suddenly having speech difficulties (speech disorders ...)
·       Having difficulty staying awake and alert outside of nap and sleep hours
·       The onset of seizure disorders or acute headache (very intense, unusual and brutal headache, sudden vision disorder)

What to do in case of symptoms?

 The very sudden onset of some symptoms - obviously out type of trauma or injury fall - (inappropriate words, inability to speak, vision problems (blurred vision, blindness ...), numbness, weakness, inability to move one side of the body , very intense headaches, convulsive disorders, change in alertness, loss of balance, nausea or vomiting ...) can be considered as warning signs of stroke. These symptoms increase in minutes. 
They can sometimes occur during sleep and can be very marked when the child wakes up. When in doubt, do not wait for these symptoms to persist and react immediately. Call 15 (UAS).
The UAS regulatory doctor will organize the transfer to a Neurovascular Unit, if the suspicion of stroke is confirmed," says the Stroke Research Foundation. And to add "that we must not minimize the symptoms by finding them a reassuring explanation and that we should not be reassured if the signs diminish." Better to call wrongly than too late ". Knowing these symptoms helps to prevent the risk of brain damage and maximizes the chances of rapid intervention.

What are the causes and treatment of stroke in children?

In the new-born, half of the causes of stroke are unknown. It is thought that this is due to a fetoplacental circulation problems (blood clots or flow problem that no longer allows the umbilical cord and placenta to feed the fetus), but it is not certain, "says the neuro-pediatrician. 
In some cases, stroke may be the result of congenital heart disease or infection, placental problems, blood clotting disorder, or severe dehydration. 
In the baby more than 28 days and children, the stroke may be due to a congenital defect, heart problems, blood vessel disorders, infection, a blood disease such as leukemia or sickle cell disease, a head trauma ... "In all cases, finding the cause can guide the care of the child," says the specialist.
there is no standard treatment for stroke in children, it all depends on the cause, the exact location of the stroke and the sequelae he left behind.
 Most often, the child will recover their motor and intellectual faculties through a psychomotor rehabilitation (in the hospital, then to liberal professionals such as physiotherapists, speech therapists or occupational therapists ...) and more or shorter depending on the type of stroke and the diagnosis that has been made. 
Drug treatments (thrombolytic drug) remain very rare in children to treat the after-effects of a stroke. "Because, on the one hand, we rarely have the authorization to administer this drug for children under 18, and on the other hand, this medication must be given within 4 hours of the beginning of the stroke.
 Most children arrive in the emergency room after this time, but the average time to visit a child for a suspected stroke is 24 to 26 hours after the onset of the first symptom, "concludes Dr. Bellesme.