Consequences after a microstroke. Stroke in childhood - myth or cruel reality Microstroke in premature babies

Microstroke is the unofficial name for one of the mildest forms of ischemic stroke - TIA (transient ischemic attack). The term "microstroke" has long and often been used, especially among patients, although such a diagnosis does not exist in official medicine. There is only a certain type of stroke.

Regarding the essence of the phenomenon, a microstroke is necessarily a transient acute violation of cerebral circulation, the symptoms of which depend on the localization of the process. It is important to note that only this type of stroke is considered a microstroke, the neurological manifestations of which disappear within 1 day, since the lesion does not have time to form.

The body still has compensatory reserves in order to eliminate circulatory disorders, but they are not unlimited. And if you do not start correcting risk factors and take preventive measures, the next time a stroke will probably be without the "micro" prefix.

Microstroke is classified according to the severity:

Easy (lasts no more than 10 minutes).
Moderate (lasts from 10 minutes to several hours, neurological symptoms completely disappear).
Severe (lasts from several hours to 1 day, minor neurological disorders may persist).

Also, micro-strokes are distinguished by the localization of the process:

Vertebrobasilar system.
Carotid artery.
Cerebral arteries.

Causes and factors of occurrence

It should be noted that there is no single provoking factor for the onset of this disease, it is always a combination of several health disorders. The main causes of a microstroke are:

Atherosclerosis (narrowing of the lumen of the vessels of the brain due to atherosclerotic plaques) This is a huge risk factor, because the narrower the lumen of the vessel, the greater the likelihood of a microstroke). The main cause of atherosclerosis is hypercholesterolemia.
Arterial hypertension (the lack of blood pressure control is the cause of the degradation of the walls of the cerebral vessels with the subsequent formation of microaneurysms, which, together with atherosclerosis, leads to more than half of the cases of strokes).
Diseases of the blood.
Cardiac pathologies leading to increased thrombosis (atrial fibrillation, myocardial infarction, rheumatological diseases, endocarditis, valve lesions of various etiologies, valve replacement, defects).
Vascular diseases, mainly of an inflammatory and infectious nature, dissection of arteries, congenital pathologies.
Osteochondrosis.

Signs and symptoms of a microstroke

To know how a microstroke manifests itself, you need to understand that its symptoms depend solely on the localization of the process. They are almost never of a general brain nature. Usually these are specific neurological disorders that are transient.

Accordingly, the signs of a microstroke can be divided into groups according to the basin of the artery in which the circulatory disorder has occurred:

Basin of the carotid artery (various visual impairments on the affected side, hemiparesis, pathology of sensitivity, speech changes).
Vertebro-basilar system (dizziness, nausea, dysarthria, diplopia, impaired motor and sensory activity, hemianopsia, visual impairment).
Ocular arteries (transient blindness of one eye).
Hippocally-fornical region (impairment of short-term memory)

Complications of the disease

The most severe complication, which usually occurs with a microstroke, is the persistence of the manifested neurological disorders in a mild degree. However, if the reasons that caused the microstroke are not eliminated and the patient ignores his condition, the violation of cerebral circulation will necessarily recur and a full-fledged stroke will occur, which rarely goes away without complications.

Diagnostics

Due to the short duration of the manifestations of a microstroke, patients do not always consult a doctor. However, if this happens, the main diagnostic criterion is the presence of characteristic neurological symptoms.

First of all, you should contact a neurologist - it is he who knows how to treat a microstroke. Instrumental examinations can often turn out to be uninformative, since the infarction zone might not have time to form. Even such highly informative methods as computed tomography or ultrasound of the arteries of the brain, which are usually used, can only indicate indirect symptoms. Additional optional diagnostic methods include:

Angiography of the vessels of the brain.
Echocardiography.
Magnetic resonance imaging.
Positron emission tomography.

Treatment of a microstroke

Due to the fact that neurological symptoms in 90% of cases go away on their own and outwardly without a trace, the treatment of a microstroke is aimed at preventing subsequent larger strokes.

The main areas to be worked on are as follows:

Treatment of arterial hypertension and strict control of pressure.
Treatment of atherosclerosis and control of the diameter of the main vessels of the brain.
Treatment of concomitant cardiovascular diseases.
Monitoring blood glucose levels and ongoing maintenance therapy in the presence of diabetes mellitus.
Compliance with the diet, smoking cessation.

Medicines and drugs

If necessary, drug therapy, patients are prescribed the following drugs:

Antiplatelet agents (aspirin, clopidogrel) are a long-term daily intake.
Anticoagulants (heparin, warfarin) - in the presence of concomitant cardiovascular pathologies.
Statins (atorvastatin) - to lower cholesterol levels.

Treatment with folk remedies

Treatment of a microstroke folk remedies is fortifying in nature. It is not capable of replacing medical prescriptions. But at the same time, it is quite effective as a support for the body during the fight against the manifestations of a microstroke.

The basic recipes are as follows:

Daily intake of sage infusion for a month.
An infusion of celandine is taken 20 drops three times a day for 3 months.
Infusions and decoctions of spruce cones, needles and bark with a constant daily intake are popular.
A good effect is obtained by using a mixture of crushed lemon, garlic and honey. Alternatively, lemon can be used as a compress, taken in a bath, and added to food and drinks.
Olive oil is mixed with crushed bay leaves, honey and lemon, slightly heated and taken three times a day for six months in a tablespoon.

Prophylaxis

Prevention of a stroke includes the following activities:

Mandatory control of blood pressure and treatment of arterial hypertension.
Constant control of cholesterol and glucose levels.
Compliance with the diet.
Taking antiplatelet agents.
Moderate physical activity.
Timely identification and treatment of cardiovascular pathologies.
Increased attention to the possible manifestation of neurological manifestations and consultation with a doctor.

Diet for microstroke

Nutrition after a microstroke is adjusted, depending on the concomitant diseases that caused the impaired blood flow. Usually the diet is aimed at lowering cholesterol.

The general principles are as follows:

Reducing the consumption of animal fats: mayonnaise, butter, fatty meat, lard and other similar products.
Reducing salt and sugar intake.
It is recommended not to overuse flour dishes.
Increase in the daily menu of the amount of fruits, vegetables, lean meat, seafood, nuts.
Avoiding alcohol, canned and pickled foods.

Features of the course of a microstroke in children

An important and dangerous feature of a microstroke in children is its "invisibility". Symptoms are much less pronounced than in adults, and neurological manifestations pass quickly and are rarely noticed. Microstrokes in children almost always occur due to severe congenital vascular defects, heart or blood diseases.

Therefore, children often do not receive adequate treatment, and instead of a microstroke, a complicated stroke subsequently occurs. It is important not to be negligent about the presence of atypical neurological manifestations and consult a doctor in a timely manner.

Stroke in children occurs less frequently than in adults and the elderly, but its consequences are no less dangerous. Untimely diagnosed hemorrhagic and ischemic strokes in childhood can cause disability and death, making it important for every parent to identify them at an early stage.

Statistics

Stroke is considered to be a disease of the elderly: according to statistics, 7.3% -10.5% of men and women aged 70-80 suffer from this disease. Children are less likely to be diagnosed with this diagnosis, since they are less susceptible to risk factors associated with its appearance.

Most often, a stroke in a child occurs in the prenatal or early neonatal period: 1 case in 4000 newborns. Children under 3 years of age have an increased risk of pathology, who account for 38% of the total number of diagnosed strokes.

Boys are more likely to suffer from this problem, and in girls, the risk of developing the disease increases during adolescence. Preschoolers and adolescents have fewer strokes than infants: 1-2 per 100,000 people.

Varieties

Stroke- This is a violation of the blood supply to the brain, leading to the death of cells to which oxygen and other substances are not supplied. Without them, cells are able to live from 2 to 6 minutes, after which their performance cannot be restored. The defeat leads to disturbances in the functioning of the body and loss of functions, the responsibility for which was borne by the dead cells.

The cause of the occurrence determines 2 types of stroke:

ischemic;
hemorrhagic.

Hemorrhagic stroke in children it occurs due to cerebral hemorrhage as a result of rupture of the walls of blood vessels. This leads to two consequences at once: the blood ceases to flow to the cut off areas of the brain, and the hematoma formed at the site of the rupture exerts pressure on the nearby vessels and tissues.

Manifestation ischemic stroke- exsanguination of tissues, resulting from blood clots, which clog the lumen of the vessels of the brain. As a result, blood stops flowing to the cells or its amount is insufficient to continue normal functioning.

According to the time of occurrence, children's strokes are divided into 3 periods:

intrauterine, or fetal;
neonatal stroke, or perinatal, - from the first days of life to 1 month;
juvenile type - from 1 month to 18 years.

Causes

Perinatal and fetal strokes can be influenced by the mother's lifestyle, health and pregnancy.

Among the main risk factors in this case are:

smoking, use of drugs and alcohol by the mother;
chronic hypertension, frequent crises;
detachment of the placenta at different times, due to which the fetus felt a lack of oxygen;
diabetes;
infectious diseases of a different nature;
rupture of the membranes before the onset of labor, the result of which was the earlier rupture of amniotic fluid.

Newborns are more likely to suffer from birth trauma, manifestations of congenital and acquired diseases in the first days of life. In adolescents, craniocerebral trauma, high psycho-emotional stress and drug use are added to the causes of strokes.

Risk factors in newborn babies

The causes of stroke in infants are more often associated with congenital abnormalities and the course of labor. This group accounts for more than 30% of all childhood strokes.

Among the main causes of the onset of the disease in children are:

traumas of the brain, skull, cervical vertebrae received during childbirth;
intrauterine infections and fetal hypoxia, pathologies of various origins during pregnancy;
difficult and long labor that caused hypoxia;
neoblastic processes;
early or late childbirth;
compression of the artery of the spine;
bacterial endocarditis;
Wergolf's disease, diseases associated with blood clotting processes and leading to the formation of blood clots;
genetically transmitted diseases, among them Moya-Moya disease, manifested in the narrowing of the intracranial arteries;
sickle cell anemia, which is more common in children with dark skin;
cerebral ischemia;
meningitis, neuroinfection, chickenpox, which increases the risk of stroke by 3 times.

Risk factors in preschoolers

In children preschool age the disease is less common. In children over 3 years old, one of the main causes of ischemic stroke are blood diseases, which, according to various sources, suffer from 15% to 50% of children. The increased activity of a child at this age causes head and neck injuries, which can provoke a stroke.

Other reasons include:

TBI, often after a fall;
acute poisoning;
vitamin deficiency, iron and vitamin C deficiency;
the first manifestations of arterial hypertension;
blood diseases, including aplastic anemia and leukemia;
endocarditis;
vasculitis;
aneurysms.

The causes of ischemic circulatory disorders are called:

diabetes;
severe dehydration leading to thickening of the blood;
viruses affecting blood vessels, inflammation of the meninges and brain;
congenital heart disease or its valves, cerebrovascular pathology, arteriovenous malformation;
oncological diseases;
autoimmune and metabolic diseases.

Adolescents are the most protected category of children. The causes of problems with disorders of the blood supply to the brain described above occur less often in them. To the risk factors at this age are added high injuries, the use of illegal and unhealthy drugs, high emotional stress and nervous overstrain.

How does the disease manifest

Symptoms of brain blood supply problems in children and adults are the same. The difficulty in diagnosing in a timely manner is that babies are not capable of full-fledged communication. Unlike adults, whose symptoms are immediately visible, children cannot explain their feelings, which makes it difficult to make a diagnosis.

The problem is compounded for newborns, in whom the reaction to a stroke is similar to that of external stimuli. It is important for parents to closely monitor the behavior of a child of any age and call an ambulance at the first suspicion of a stroke, since delay can have consequences for the health of the baby.

When to suspect a stroke in a child

Often, signs of vascular pathologies in young children go unnoticed, since they passed without symptomatic manifestations.

In order not to miss the onset of the disease, you should carefully consider the appearance of the following signs in the child's behavior:

sharp headache, dizziness, visual and hearing impairment, loss of consciousness;
unreasonable nausea and vomiting;
when smiling, the corners of the lips rise on only one part of the face;
coordination of movements is impaired: when you try to raise both hands in front of you, one will not obey;
speech becomes inarticulate, reactions become inhibited, consciousness confused;
one of the eyes may begin to squint, a sharp deterioration in vision is detected.

4 main symptoms

Among the mass of concomitant manifestations, 4 main symptoms of childhood stroke can be distinguished:

Complete or partial paralysis of the limbs, in most cases the inability to move an arm or leg on one side, sagging of the right or left half of the body, impaired coordination.
Signs of clouding and confusion of consciousness, stunnedness, in severe cases - a coma.
In older children - speech impairment, distortion of words, inability to repeat entire sentences, slurred and inhibited speech.
Violent and repetitive cramps in the limbs, muscle tension in the occiput and neck.

Other symptoms

The complex and the strength of the manifestation of symptoms will depend on the type of stroke, the focus of the lesion and the degree of vascular damage.

In combination with the main manifestations, there may be:

memory loss;
deviation of hearing and tactile perception;
nystagmus, a sharp expansion of the pupil to the edges of the iris without a reaction to light, the loss of fragments from the field of view;
lethargy, lack of motivation, frequent mood swings;
sharp involuntary movements of parts of the body, impaired coordination;
paralysis of the limbs.

With a cerebral hemorrhage, a sharp loss of consciousness, meningeal and cerebral symptoms is possible. Ischemic damage will primarily have neurological manifestations.

Features in children of the first months of life

It is especially difficult to diagnose disorders of blood supply in the brain in newborns and children in the first months of life. This is because symptoms of the disease can be confused with other conditions. The situation is complicated by the fact that hemorrhages in infants can be extensive, leading to irreversible consequences if the treatment was incorrect or untimely.

In this regard, special attention should be paid to the appearance of the following symptoms in the first months of a child's life:

breathing disorders: frequent or intermittent, up to a stop;
tension in the back of the head;
convulsive manifestations;
sagging of one part of the body;
frequent regurgitation, problems with swallowing, vomiting, impaired sucking reflex;
movements with only one leg or hand;
increased anxiety, anxiety, a sharp reaction to any stimuli, including touching, loud sounds, bright light;
lack of sleep;
sudden mood swings, lethargy, or excessive, incessant crying;
visual impairment, a sharp appearance of signs of squinting eyes, lack of focus.

It is important to closely monitor the child's condition in the first days and months of life and, if symptoms appear, insist on additional examinations.

Periods

There are 5 periods of the course of the disease:

Sharpest- manifests itself as much as possible during the first 3 hours. Stored up to 3 days from the moment of the incident. The most important stage for diagnosing and eliminating manifestations: timely treatment can minimize the consequences.
Spicy- from 4 to 14 days. It is aimed at reducing the risk of relapse, eliminating cerebral edema, normalizing the state of the blood, the work of the heart and blood vessels.
Early recovery- up to 6 months. Complex therapy to eliminate the consequences, increase the sensitivity of damaged areas, and normalize speech.
Late recovery- from 6 months to a year. Restoration of all possible functions, continuation of rehabilitation measures.
Period of residual effects- up to 2 years. Work on complex consequences, adherence to recommendations and implementation of preventive measures.

The main danger of intrauterine stroke is the inability to recognize it until the moment of delivery. If the damage to the cerebral vessels of the child during the mother's pregnancy was extensive, the consequences can affect the development of motor skills, psychoemotional state, motor activity, and manifest itself in developmental delay.

Diagnostics

The clinical manifestations of childhood strokes can be blurred, so doctors prefer to rely on instrumental methods.

If, upon examination by a pediatric pediatrician, neurologist, neonatologist or neurosurgeon, there is a suspicion of a stroke, the following studies are carried out:

blood for clotting, inflammatory processes, biochemistry;
in infants: ultrasound through the fontanelle;
3-5 days MRI or CT;
the angiographic method with the introduction of contrast is one of the most accurate;
duplex scanning of arteries and veins;
if other options are impossible or inaccurate - spinal puncture to detect hemorrhage.

Differential diagnosis

The absence of vivid manifestations of ischemia and cerebral hemorrhages in newborns makes it difficult to identify and correctly define the disease, so a third of cases remain unnoticed or incorrectly diagnosed.

Stroke symptoms can mimic those of diseases such as:

brain tumor;
abscess;
complicated migraine;
juvenile Parkinson's disease;
liver poisoning;
subdural hematoma;
certain types of infections;
Todd's palsy, encephalitis, neurological diseases.

The final picture can only be given by studies of fluids and organs carried out on specialized medical equipment.

Treatment

Symptoms, diagnostic options, and treatment options will vary by age. It is important to pay attention to changes in the child's behavior in order to timely identify the possible onset of a stroke. Starting therapy in the first 3 hours after the incident will minimize its consequences as much as possible.

Only a doctor can prescribe therapy; in no case can a stroke be treated on its own.

If an operation is necessary to remove a blood clot, an emergency surgery is prescribed with the participation of a neurosurgeon. In severe manifestations and after surgery, the child is transferred to the intensive care unit until the condition stabilizes.

Depending on the type of vascular lesion, drug treatment: anti-thrombotic in ischemia, stopping and restoring blood in hemorrhages.

Drugs are used to normalize blood pressure, improve brain activity, and eliminate symptoms.
In the future, rehabilitation treatment is required in a neurology hospital. The final part is rehabilitation in specialized centers and carrying out supportive measures at home.

The likelihood of relapse

Children are 30% more likely to have a recurrent stroke than adults. The risk of relapse is especially high in the first year after recovery. During this period, it is important to follow all the recommendations of doctors, to continue treatment, rehabilitation and preventive measures. At the first symptoms of the disease, worsening of the condition and regression, you should immediately seek help.

Most often, relapses occur in children and adolescents with chronic pathologies of the heart and blood vessels, hypertension, and diseases of the circulatory system. If there are no such diseases, and the causes of the first stroke have been eliminated, the risk of re-development is minimal, provided that all recommendations are followed.

Effects

Due to the fact that the child's body is in the stage of active growth and development, a stroke is more easily tolerated than in adults. The ability to regenerate and grow contributes to the replacement of dead cells and the emergence of new neural connections. In most cases, with proper treatment, a child will recover completely after a stroke.

However, with late diagnosis and incorrect therapy, the following consequences arise:

Mortality in every 5 case, the most dangerous in this regard is the hemorrhagic type.
10% of children will need constant care.
In 70% of cases, permanent or temporary disturbances in the form of paralysis, developmental retardation, memory loss, speech, swallowing, visual or motor functions disorders, neurological diseases, emotional instability are possible.

Prophylaxis

In order to avoid a stroke, it is necessary to regularly examine the child for the presence of diseases of the heart, blood and blood vessels. This will make it possible to promptly diagnose a predisposition to stroke and prevent its occurrence. To prevent recurrence, the doctor may prescribe drugs with acetylsalicylic acid and heparin.

An important point is the child's lifestyle and diet.

It is worth regulating his physical activity depending on his state of health, spending more time on walking in the fresh air, monitoring sleep and wakefulness: rest should be at least 8 hours daily. Promotes the prevention of strokes and a diet based on the absence of fatty foods.

The conventional wisdom that stroke is a purely "adult" disease is fundamentally wrong. Stroke in children is not such a rare occurrence. What's even worse is that the disease often affects newborns. Of course, older people, after 65 years of age, still suffer from disturbances in the blood supply to the brain. If we consider the statistics on childhood morbidity, the picture is as follows: 6 cases per 100 thousand children. In addition, it should be noted that the clinical picture and the first signs of stroke in young children will differ slightly from adult manifestations.

The timely supply of blood to the brain guarantees the normal functioning of both the organ itself and the body as a whole. If its blood supply is disrupted, then a stroke occurs. The brain is left without oxygen and essential nutrients, as a result of which its tissues suffer. The classification of cerebral hemorrhages in children will directly depend on the given assessment criteria. So, based on the age of the baby, they distinguish:

fetal stroke (in the prenatal period);
perinatal (arising from the 28th gestational week to the month of the baby's life);
children's stroke (manifests itself in the period from the 29th day of a child's life to his majority).

According to the type of origin, cerebral stroke in children is divided into:

ischemic;
hemorrhagic.

Ischemic stroke in a child occurs as a result of blockage of a cerebral vessel by a thrombus (ischemia). A clot can form in any of the vessels of the body and, through the bloodstream, enter the vascular system of the brain. Ischemic cerebral stroke in children can also be thrombotic, non-thrombotic and embolic.

Hemorrhagic stroke in young children occurs as a result of a ruptured blood vessel, due to which large volumes of blood begin to accumulate under the lining of the brain or directly in its substance. This provokes unnecessary pressure on nearby tissues and leads to disruption of their functions. It is parenchymal, subarachnoid, subdural and epidural.

Causes of occurrence

As already mentioned, a hemorrhagic stroke is characterized by a ruptured vessel. Why does this problem occur in children? There are several factors and reasons for this:

tumor;
aneurysm;
high blood pressure;
traumatic brain injury;
vitamin deficiency or intoxication;
blood diseases (hemophilia, leukemia);
drug or alcohol dependence of the mother.

In the case of ischemic stroke, a blood clot clogs the vessel, which leads to a heart attack. The formation of such blood clots can be facilitated by:

diabetes;
cerebral vasculitis;
Congenital heart defect;
bacterial endocarditis;
heart valve replacement;
anomalies of veins, arteries and capillaries;
infectious ailments (chickenpox, meningitis, and others).

Rarely, an ischemic stroke in a child is preceded by problems with the mother during pregnancy. As a rule, we are talking about a consistently high pressure, placental abruption, interrupting the supply of oxygen to the fetus or early discharge of water (one day before delivery). As for adolescents, they may have an ischemic stroke due to the use of amphetamines, cocaine, or due to poisoning with maninil or isoniazid.

Symptoms

A stroke in children has the same symptoms as in adults. That is, there is a cloudedness of consciousness, vision deteriorates, weakness suddenly arises and speech becomes slurred. However, diagnosing the condition and identifying symptoms in infants is often difficult, since they are not able to describe their condition, and relatives rarely focus on the appearance of neurological manifestations in the baby. As for children from 1 to 4 years old, their first signs of a stroke may also be accompanied by the following symptoms:

apnea;
lack of appetite;
limb cramps;
delayed physical development.

In older babies, a decrease in concentration of attention is observed and paralysis of one of the limbs is possible, which then spreads to the whole body. There is also a connection with the hemisphere of the brain in which the hemorrhage occurred, so the symptoms can change. When the right hemisphere is affected, the movements of the left side of the body become more complicated and the child often has problems buttoning the buttons on this side of the garment. In addition, the baby loses the ability to adequately assess the position and size of objects. If the left hemisphere is affected, then it is difficult for the child to speak, since this area of the brain is responsible for speech and language. There is also the sharpness and clumsiness of the movements of the right side of the body.

Dizziness or severe headache as a symptom of stroke in children

You need to be especially careful about the following symptoms in children:

loss of memory;
swallowing problems;
unilateral paralysis;
a sharp deterioration in vision;
difficulties in pronunciation of words and in the perception of speech;
dizziness, problems with spatial orientation;
intense headache, which is often accompanied by vomiting.

If a child has at least one of the listed symptoms, an ambulance should be called without delay.

Diagnostics

The most important period when medical care is most effective is the first 3 hours after the onset of stroke symptoms. If you suspect a stroke, you need to do the following:

evaluate the symmetry and naturalness of the baby's smile;
ask the child to raise his hands up - this is how the weakness of one of the limbs is revealed;
pronounce any phrase and ask the baby to repeat what he heard: this is how speech and memory disorders are determined.

If a crooked smile, disturbances in movements and speech are found, then, most likely, the child has a stroke and needs to be urgently hospitalized. In a hospital setting, to confirm the diagnosis, the baby can be assigned the following types of diagnostics:

MRI of the brain;
radiography;
echoencephalography;
dopplerography of blood vessels;
laboratory tests of urine and blood.

First aid

Until the ambulance arrives, you need to be able to provide the child with the first pre-medical aid. First of all, you need to lay him on his back, placing a high pillow under his head (in order to avoid the development or progression of cerebral edema). Next, you should remove all the embarrassing clothes from the baby (unbutton the collar, belt, belt).

Then open a window or window for a better flow of fresh air. In case of vomiting, you need to turn the baby's head to the sides and clear the mouth of mucus and vomit. If the baby has stopped breathing (with extensive stroke), it is necessary to start resuscitation.

Treatment

After the detection of the first symptoms of a stroke in a child, it is necessary to prescribe treatment (in the first 3-6 hours), due to the very rapid damage to brain cells.
Indeed, with their massive defeat, the consequences are often irreversible. First of all, doctors identify the type and cause of stroke, after which they eliminate the most dangerous symptoms that provoke the progression of stroke (cerebral edema, high blood pressure, heart problems).

In case of severe pain syndrome, pain relievers are administered, anticonvulsants - in case of intense convulsive syndrome, antioxidants and nootropics to restore neurons. Further specific treatment will directly depend on the type of stroke (ischemic or hemorrhagic). After stabilization of the patient's condition, physiotherapy, exercise therapy, massage, work with a speech therapist and a psychologist are introduced, as well as prevent complications.

Complications and consequences

The consequences of such a blow in childhood can be quite severe. So, in the future it is possible:

development of cerebral palsy;
paralysis and paresis;
loss of sight and hearing;
mental retardation;
persistent speech disorders;
problems in the work of the pelvic organs;
the formation of mental retardation;
persistent deviations in the coordination of movements;
psychological problems (changes in mood, behavior, character).

Timely diagnosis and therapy for childhood strokes contributes to the gradual restoration of brain functions and minimizes the consequences of this pathology.

A significant role in this process is played by the attitude and moral support of the parents, as well as the passage of a full course of rehabilitation.

Rehabilitation

Rehabilitation activities in children should begin as early as possible. Therefore, after assessing all the neurological problems and the severity of the little patient's condition, they consider the possibility of an early rehabilitation course. Such activities are carried out according to an individual plan, first in specialized institutions, and then, at home. In parallel with this, parents are introduced to all the nuances of the recovery program so that they can provide psychological support to the child at all its stages.

Stroke refers to diseases that, as they say, and the enemy does not wish. Acute violation of cerebral circulation with damage at the cellular level, and this is what happens with a stroke, is fraught with serious consequences up to death.

Stroke was previously considered a disease of the elderly. There is even a rule that every decade after 20 years of age doubles the risk of its occurrence. Therefore, people to the question "Does a stroke occur in newborns or older children?" answered in the negative.

However, the development of medical diagnostic technologies made it possible to establish that it also occurs in the prenatal period. Just before the invention of computer research methods, doctors, without further ado, diagnosed a child with mental and motor disabilities with cerebral palsy.

Stroke also happens in children

Before finding out what the danger of a stroke in children is, what causes it, and what symptoms are observed with a sudden violation of the blood supply to the brain, it is necessary to classify a stroke in children according to the time and mechanism of development. Because the causes, symptoms and effects may vary.

Stroke by time of occurrence

If damage to the blood flow to the brain occurs between 14 weeks of gestation and the onset of labor, the stroke is classified as fetal.
Perinatal stroke occurs between 28 weeks of gestation and 28 days of a newborn's life.
There is also a definition of "neonatal". It is used when a stroke occurs between the onset of labor and 28 days after birth.

What caused this overlapping classification is difficult to say.

A juvenile stroke is considered when it occurs in childhood and adolescence (from one month of age to 18 years).

Developmental stroke

The factor defines two types:

ischemic;
hemorrhagic.

Ischemic stroke

The first type is most often found in adults and is caused by atherosclerosis of the vessels that feed the brain. Blockage of a blood vessel with a cholesterol plaque or thrombus leads to the fact that brain cells cease to receive oxygen, and then they will inevitably die. In children, the causes of ischemic lesions are different.

Hemorrhagic stroke

The second type causes a rupture of a vessel in the brain. Blood enters the brain tissue, as a result of which they lose the ability to perform their functions.

Causes of Stroke

May be different depending on the period of development of the child.

Intrauterine period

During this time, a stroke can affect the child's brain due to a heart defect.
Certain genetic diseases can lead to ischemic type, for example: sickle cell anemia.
Hemorrhagic stroke is a common cause of arteriovenous malformation (an anomaly caused by an incorrect connection of blood vessels).
The same type of stroke occurs with a vascular aneurysm.

Being in the womb, the child depends on the state of her health.

Placental abruption during pregnancy leads to a deterioration in the blood supply to the fetus, to cerebral ischemia, which turns into a stroke.
Diabetes mellitus is another negative factor.
A stroke can occur in the fetus if the pregnant woman develops preeclampsia. With it, the pressure rises, the limbs swell. Preeclampsia affects many organs, but the brain suffers the most.
Severe infectious diseases are another reason.
Drug use, alcohol and smoking increase the risks of impaired blood supply to the brain.

Newborn period

Stroke in newborns has other causes and is a consequence of obstructed labor. These consequences lead to:

rupture of the fetal bladder more than a day before childbirth;
protracted childbirth, in which the child experiences oxygen starvation;
traumatic brain injury.

The baby's skull is vulnerable, and it can suffer during childbirth due to various circumstances.

The fetus may be too large for the birth canal.
The cranial bones and brain can be injured by a rigid cervix or its incomplete dilatation during rapid labor.
Unsuccessful manipulation by nursing staff during childbirth is another cause of skull injury.
If the baby is premature, it may have overly soft skull bones.

However, the result for all the complications leading to impaired blood circulation in the brain is the same - cell death of the brain in stroke in newborns.

Juvenile period

During this period, a stroke is caused by either head injuries or vasculitis:

autoimmune;
infectious;
medication.

Sometimes hemophilia or Moyamoya disease may be the cause. With hemophilia, there is poor blood clotting. Moyamoya is a rare disease leading to thickening of the arteries in the brain and narrowing of their lumen, up to the complete blockage of blood flow.

Hemorrhagic and ischemic stroke in a child (consequences)

The consequences can be different, since they depend on the severity of the brain damage.

Mild stroke in fetal or perinatal periods does not give a clear clinical picture. Children develop normally, only at a slower pace. Dr. Komarovsky believes that such children need more attention and care from their parents than their healthy peers.
More extensive brain lesions often lead to epilepsy. Seizures can range from involuntary shaking of one arm or leg to a generalized seizure with loss of consciousness and a fall.
Can be observed:

one-sided body weakness;
difficulty moving around;
partial loss of vision;
problems with speech;
decreased intelligence;
difficulties in communicating with other people.

Signs of a stroke

Children are less likely to analyze well-being than adults. Symptoms are less pronounced, especially for mild lesions, which, for example: gives a microstroke in children. Therefore, parents should be very attentive to changes in their behavior.

Stroke or microstroke can be talked about:

various kinds of convulsive body movements;
sudden vomiting;
headache complaints;
dizziness and loss of balance;
slurred speech;
immobility of one side of the body;
using only one hand in everyday life;
difficulty swallowing;
a sharp change in mood for no apparent reason.

First aid before the ambulance arrives:

Immediately put the child to bed, put pillows under the head so that it rises 30 degrees above the bed level.
Unbutton your clothes so that they do not interfere with breathing.
Provide fresh air in the room.
When vomiting appears, turn the child's head to one side so that he does not choke on vomit. After vomiting, clear your mouth.
Call emergency medical attention immediately, as the child's life is in danger!

You can't do without the help of a neurologist

What to do after a stroke

After the course of treatment, the child should be under the supervision of various doctors:

neuropathologists;
physiotherapists;
speech therapists;
massage therapy specialists

Massotherapy

The duration of recovery and the success of rehabilitation depend on how their recommendations are implemented. Do not hesitate to ask again, to clarify, in order to avoid mistakes during the rehabilitation period. It is useful to read literature on this topic, watch TV shows, go to sites.

Even if the child's stroke was severe, it must be remembered that the child develops a central nervous system, and he has more chances of returning to a full life than an adult. And these chances should never be missed.

Smirnova Olga Leonidovna

Neuropathologist, education: I.M. Sechenov. Work experience 20 years.

Articles written

To an untrained person, it may seem that a stroke in children cannot occur, since it is traditionally believed that this disease is associated with age. But children have a stroke, albeit very rarely, so it is imperative to know the causes that cause it. This disease can proceed secretly, especially in, and its manifestations are dangerous to the health and life of the baby.

There are two types of strokes:

ischemic, associated with the brain. With it, the vessel is tightly clogged with a blood clot - a thrombus, which interferes with the movement of blood and causes circulatory disorders, oxygen deficiency of brain tissue. If this condition persists for a long time, the affected area of the medulla may die. Because of this, they can affect any organ (system) of the human body, which was controlled by the affected part of the brain;
hemorrhagic, caused by hemorrhage. A bursting vessel releases a large amount of blood into the medulla, which coagulates and forms a clot - a hematoma. It presses on a vast area of the brain, which can lead to very serious consequences - from paralysis and complete immobility to the death of the patient. The severity of the injury depends on which part of the brain is affected by the stroke.

Children mainly suffer from the first form of the disease, that is, from a. This is a relatively milder form of the disease, since hemorrhagic stroke is more common in older people, causing many times more dangerous health consequences. It is this form of the disease that is the main cause of death.

Causes of occurrence in childhood

The main reason for the development of a stroke in a child is a violation of cerebral circulation. It can manifest itself at different ages, therefore, children's stroke is divided into the following age groups:

Intrauterine, or perinatal.
Newborn stroke.
Disease in adolescents under the age of 18.

In the first two groups, the frequency of diagnosis of the disease is one case per 4000 children. In the third group, the incidence of the disease drops sharply, to one per 100 thousand teenagers.

The severity of the disease and the level of danger of its consequences for health depend on which part of the child's brain the stroke occurred, and on its form.

The hemorrhagic form is rare, most often it is provoked by traumatic brain injury during impact or very difficult childbirth. It is associated with a violation of the integrity of the vessel and the outpouring of blood, which leads to the formation of a hematoma.

Most common reasons capable of provoking:

(thinning and protrusion of the vessel wall, threatening its perforation);
high blood pressure;
presence - or malignant;
intoxication;
blood diseases (acute leukemia, hemophilia (genetically determined bleeding disorder, aplastic anemia, hemoglobinopathies, including sickle cell anemia);
alcoholism or drug addiction of the mother during gestation.

The following reasons lead to the development of ischemic stroke, which is also called cerebral infarction, in children:

during intrauterine development and at the time of birth;
cerebral vasculitis, which is especially susceptible to children with autoimmune diseases;
anomalies in the structure and functioning of the vascular system;
Congenital heart defect;
surgery to install an artificial heart valve;
diabetes;
chicken pox;
high blood pressure in the mother during pregnancy with edema of the lower extremities;
abuse of alcohol, drugs or drugs by a pregnant woman, smoking;
detachment of the placenta, which caused oxygen starvation of the fetus;
discharge of amniotic fluid with late onset of labor (more than 24 hours).

All of these conditions can cause a baby to be born with a stroke, or develop it early in life. Adolescents are more likely to suffer from strokes, which are manifested due to very high physical or emotional stress, as well as due to brain trauma, diseases.

How do symptoms appear?

Signs of a stroke in children born with it may go unnoticed due to their lack of expression, blurredness in a very young child. Such a baby may not differ in any way from his peers, it will just develop a little slower.

More serious injuries in intrauterine lesions lead to seizures, appetite disorders, slight or severe developmental delay, breathing problems, which can be expressed in apnea - a short-term cessation of breathing, especially dangerous during sleep.

Symptoms are more pronounced in adolescents. They are manifested by paralysis, confusion of speech, weakness, impaired movement, decreased concentration and learning ability, headaches and dizziness, so they immediately attract the attention of parents. Often such children become more emotional, quickly lose their temper, get angry and cry, less often they are withdrawn and aloof. It is very important not to leave your child alone with the problem, you need to communicate with him a lot, support him and stimulate the desire to recover.

Potential health hazard

The onset of a stroke can be sudden and seriously threaten the health and life of the child. If the following symptoms appear, you must urgently call an ambulance:

Severe or persistent headaches, especially when accompanied by nausea and vomiting.
Concentration disorders, distraction, disorientation.
Problems with or complete loss of it.
Indistinct, "connected" speech.
Respiratory disorders.
Swallowing problems.
Impaired mobility of half of the body if one half of the brain is affected.
Convulsions.
Paralysis.

These are very dangerous symptoms, and the salvation of a child largely depends on a prompt response to them and delivery to a hospital. A stroke in children can be threatened by the following consequences:

cerebral paralysis;
mental and physical retardation;
violations of motor function;
complications in sight and hearing;
psychological disorders;
difficulties with the socialization of the child.

Various medical specialists, not only related to brain problems, can treat babies and adolescents with cerebrovascular accidents. Such a child will need classes with a speech therapist, physiotherapists, psychologists and representatives of other medical specialties.

Treatment

With the hemorrhagic form, treatment primarily consists of removing the blood clot and stopping the bleeding. This can be done by an extremely operative method and as quickly as possible, since the hematoma presses on parts of the brain and provokes further health problems. After the surgical intervention, doctors take measures to control the breathing of the little patient, monitor the level of blood pressure and body temperature.

To complete the therapy, the patient is prescribed a set of medications designed to solve various problems: to level the risk of infection, normalize blood circulation, strengthen the body, and stimulate immunity. The drugs are selected exclusively by a specialized specialist, and the duration of treatment depends on the severity of the patient's condition.

After undergoing surgical treatment, the child will need restorative therapy. During this period, the parents and loved ones of the baby will need to show maximum attention, in every possible way to support and approve of all the achievements of the child. Even in very severe cases, young children have a good chance of full recovery.

In ischemic stroke, treatment is mainly medication, aimed at resorption of the thrombus, etc. Patients are prescribed drugs that prevent increased blood clotting, as well as nootropic drugs, supportive and strengthening therapy. It is very important to deal with the child, and not only to treat him with medication. In the presence of physical problems, modern hardware techniques also come to the rescue, speech disorders are restored with special classes.

The baby's body needs to be strengthened and tempered, ensure proper healthy nutrition, and spend more time with him in the fresh air. But the most important thing is to love and support him, not to fold your hands even in very difficult and difficult situations. Modern medicine is developing and finding new ways to restore health to such patients.

Despite its obvious fragility, the body of a small person grows and develops, and the forces put in it by nature are enough to cope with the most serious diseases. The goal of the child's doctors and relatives is to help him withstand a complex disease and defeat it.