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Stroke in Children

 What is Stroke?

Stroke is defined as sudden onset of focal neurological deficit due to occulsion of blood supply or hemorrhage in the brain causing sign/symptoms lasting greater than 24 hours.

 

Types of Stroke

1) Ischemic Stroke

a)Arterial Stroke

Congenital heart diseases

b)Venous Stroke

Infectious stroke

 

2)Hemorrhage Stroke

Occurs mostly in children

                                         Ischemic Stroke

Arterial Stroke 

All Cardiac diseases

Transient Arteriopathy

Vasculitis

Congenital infection,anemia,Tumour

 

Venous Stroke

Thrombus formation

Cerebral Venous

Sinus thrombosis

Infection

Fever

Dehydration

                                       Hemorrhagic Stroke

 

Ateriovenous malformation or due to any infection that may result in brain rupture

Causes of stroke in Children

1) Congenital

Aortic Stenosis

Mitral Stenosis

VSD

Sinotic congenital heart disease

 

2)Acquired

Endocarditis

Arrhythmias

Cardiomyopathy

Rheumatic fever

Soratic heart disease

 

 

3) Blood disorders

WBC’s Disorders

Leukemia

Lymphoma

RBC’s Disorders

Polycythemia

Sickle cell anemia

Platelet’s Disorders

Thrombocytopenia

Thrombocytosis

Coagulation Disorders 

Protein C deficiency

Factor 5 deficiency

Antithrombin factor 3 deficiency

Hemoglobinuria

Lupus anticoagulants

 

4) Vascular disorders

Aneurysm

Fibromuscular dysplasia

Arteriovenous malformation

 

5) Drug induced stroke

    Amphetamine

    Coccaine

 

6) Metabolic disorders

Homecystinuria

Febri disease

Mytochondrial encephalopathy

 

7) Other causes

Trauma

Child abuse

Placental embolism

                                Intracranial Thrombosis

Thrombus occulsion anterior,medial,posterior,basal vertebral and internl carotid artery.

 

Thrombosis most commonly occur at Atheromatous plaque and causes necrosis or stenosis of that wall.

Steps

1.Thrombus moves to distal region due to continous supply

 

2.There it Increases in size

 

3.Stop at any point according to condition

 

4.Causes ischemia of that point

 

Risk factors

Full term babies are at risk of stroke

 

Sign and Symptoms

In infants

Seizures

Extreme Sleepyness

Tendancy to use only one side of body

 

In Children/Teenagers

Weakness,numbness

Trouble in walking,loss of coordination

Pain in face,slurred speech,sleepyness

Problem in seeing and sneezing,worst headache lasting for days without relief,new appearance of seizures on affected side of bod

Differential Diagnosis

Intracranial hemorrhage

Cerebral absesce

Malignancy

Multiple sclerosis

Inhibitory seizures

Complicated migraine

Herpes simplex virus

Complications

Seizures

Increase in Intracranial pressure

HTN

Aphaxia

Skeletal deformaties

Diagnostic evaluation

1)  Within 48 hours of admission 1st line treatment is required.

2) Within 1st week of admission 2nd line treatment is required.

3) As per needed 3rd line treatment is required.

1st line treatment

Lab tests are needed in 1st line treatment

CBC,ESR,Blood sugar

Serum/electrolyte

Lipid profile test

Plain chest X-ray

MRI

USG

ECG

 

2nd line treatment

Echocardiogram

Transcranial and carotid doppler

EEG

Rheumatic fever

Aminoacid lab test

Urine test for aminoacid

Ammonia

Lipid profile

CSF

3rd line treatment

HIV

Muscular biopsy

DNA testing

Carotid MRI

Liptomenigial biopsy

Hypercoagulabel evaulation/Hematological

 

Management

1.Differentiate btw Hemorrhagic and Ischemic stroke

2.Anticoagulants are contraindicated in hemorrhage

3.If stoke is caused by intracranial hemorrhage then manage it by

Fluid ressuciation

Give Steriod in balance amount

Shunt surgery if needed

  1. Prevent HTN and hyperglycemia because they can worse stroke
  2. If stroke is caused by HTN then manage it by:  Antihypertensive drugsMaintain Fluid balancePrevent it from hyperglycemia6.
  3. If stroke is caused by Seizure then manage it by:AntibioticsAntiepilyptic drugs
  4. If stroke is caused by thrombus formation then manage it by:Antithrombin therapy(Heparin)

    Antiplatelet agents(Aspirin)

    Oral anticoagulant agents(Warfarin)     Thrombolytic agents(Streptokinase,urokinase)

Physiotherapy Management

Rehabilitaion therapy

Occupation therapy

Psycological therapy

Physiotherapy

 

Presentation of this topic is attached below:

Stroke in Children by Dr.Maria

 

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