Childhood strokes are a serious condition that develops as a result of blockage or bleeding in the vessels going to the brain and progresses with sudden neurological losses. It may present with paralysis, speech disorders, vision loss, and loss of motor functions. Early intervention is of vital importance.

Risk factors for stroke in children include heart diseases, blood clotting disorders, infections, and some genetic syndromes. If these conditions are not recognized early, permanent neurological sequelae may develop. Children in the risk group should be followed regularly.

Symptoms of stroke include one-sided weakness, facial asymmetry, sudden speech impairment, and changes in consciousness. These findings require urgent evaluation. Early diagnosis is decisive in terms of protecting brain tissue and improving the child’s functional recovery.

In stroke treatment, intensive care support, anticoagulant drugs, physical therapy, and rehabilitation programs are applied. In the long-term treatment process, children’s motor, cognitive, and social skills are supported through a multidisciplinary approach. Continuous follow-up improves quality of life.

What Is Stroke (Paralysis) in Children and What Causes It?

Stroke (paralysis) in children, just like in adults, is damage to a part of the brain due to a problem in the brain vessels. We can think of our brain as the control center of our body. Just as when there is a problem in the electrical installation of a house some lights do not turn on or devices do not work, when there is a blockage or rupture in the blood vessels of the brain, the functions of that area of the brain may also be disrupted. This is what we call a stroke.

This blockage or rupture may occur in the arteries of the brain (the vessels carrying clean blood) or in the veins (the vessels carrying dirty blood back). If an artery is blocked, the brain tissue supplied by that vessel cannot receive oxygen and nutrients, and this causes damage. Usually, in this situation, there is no bleeding in the brain. However, if a vein ruptures, bleeding may be seen in the brain. Interestingly, when a vein is blocked, sometimes there may be no bleeding and no obvious damage may occur in the brain tissue.

Stroke in children is seen less frequently compared to adults. While atherosclerosis is usually the most common cause of stroke in adults, the situation is a little different in children. The most common cause of stroke in children is heart disease. A problem in the heart may lead to clot formation, and this clot may travel to the brain vessels and cause blockage. Apart from this, trauma (especially head trauma), some blood diseases, congenital clotting disorders, infections, some vascular diseases, and metabolic diseases may also cause stroke in children.

Is Stroke (Paralysis) in Children Different from That in Adults?

Although stroke (paralysis) in children basically has the same mechanism as stroke in adults, it shows some important differences in terms of its causes, symptoms, and recovery processes. While the biggest cause of stroke in adults is generally age-related vascular wear and hardening, in children the underlying causes are more diverse and heart problems, blood diseases, or genetic predispositions often come to the forefront.

In addition, children’s brains have an incredible ability to recover. We call this “neuroplasticity.” In other words, when one part of the brain is damaged, other parts may compensate for the effects of this damage to some extent. Therefore, rehabilitation started in the early period after stroke in children can provide a much more significant improvement and reduction in the rate of sequelae compared to adults. This is one of the most hopeful aspects of stroke in children.

We call strokes that occur during pregnancy or within the first 28 days after birth (the neonatal period) “perinatal stroke.” Babies who experience stroke during this period usually present with symptoms such as using one arm or leg less or delay in gaining motor skills. These babies and their mothers are closely monitored against the risk of stroke recurrence, and physical therapy is started at the earliest period.

What Are the Symptoms of Stroke (Paralysis) in Children and How Is It Recognized?

The symptoms of stroke (paralysis) in children may vary depending on which area the stroke affects and the age of the child. However, the most important point is that stroke usually occurs suddenly. A suddenly developing weakness or partial paralysis in a child should immediately bring the possibility of stroke to mind.

Apart from paralysis, seizure and change in consciousness may also be among the symptoms of stroke. Especially when an arm or leg suddenly cannot be used, that is, when paralysis or motor loss develops, it is very important to apply to the emergency department of a healthcare institution without losing time.

• Symptoms of stroke in newborns and infants may be less clear. Situations such as irritability, excessive sleepiness, difficulty sucking, and moving one side of the body less may be seen. In older children, the symptoms may be more similar to stroke in adults:
• Sudden weakness or numbness: Especially on one side of the body (arm, leg, or face). It may feel as if that side has suddenly “failed.”
• Speech difficulty: Suddenly having difficulty speaking, not being able to pronounce words correctly, or having difficulty understanding what others are saying.
• Vision problems: Sudden loss of vision, double vision, or blurred vision. It may be as if a curtain has suddenly come down over the eye.
• Severe headache: Especially a very severe headache that starts suddenly and has never been experienced before. Vomiting may also accompany this.
• Balance and coordination problems: Suddenly having difficulty walking, staggering, or feeling off balance.
• Change in consciousness: Sudden confusion, drowsiness, or loss of consciousness.
• Seizure: Especially seizures starting on one side of the body and followed by weakness may be a sign of stroke.

It should not be forgotten that in the event of any of these symptoms appearing suddenly, getting medical help immediately is of vital importance. Timely intervention may help minimize brain damage and increase the child’s chance of recovery.

How Is Stroke (Paralysis) Diagnosed in Children?

Diagnosing stroke (paralysis) in children is very important in order to intervene quickly and accurately. When stroke is suspected in a child, doctors first learn the medical history of the child and the family in detail. Then, the child undergoes a neurological examination. In this examination, functions such as the child’s movements, reflexes, vision, speech, and level of consciousness are evaluated.

Brain imaging methods are used to confirm the diagnosis of stroke and determine the type of stroke (blockage or bleeding). At the forefront of these methods are computed tomography (CT) and magnetic resonance imaging (MRI).

• Computed Tomography (CT): CT provides rapid imaging of the brain and is especially very effective in detecting bleeding in the brain. Therefore, in a child suspected of having a stroke, CT may be performed first.
• Magnetic Resonance Imaging (MRI): MRI shows the brain tissue and vessels in much greater detail. It is more sensitive than CT, especially in the early stages of stroke and in detecting small vessel blockages. Together with MRI, magnetic resonance angiography (MRA), which allows visualization of the brain vessels, is generally also performed. If it is necessary to examine the brain veins, magnetic resonance venography (MRV) may also be used.

In addition to these, various blood tests are also performed to investigate the underlying causes that may lead to stroke. With these tests, conditions such as infection, blood clotting disorders, blood diseases, and metabolic problems can be investigated. Considering that heart diseases may cause stroke, heart examinations such as electrocardiogram (ECG) and echocardiography (ECHO) may also be performed. In some cases, especially if there is suspicion of a genetic predisposition, genetic tests may also be requested.

How Is Stroke (Paralysis) Treated in Children and What Should Be Done in an Emergency?

The treatment of stroke (paralysis) in children varies according to the type of stroke (ischemic or hemorrhagic), how much time has passed, and the underlying causes. However, the main goal is to minimize brain damage, restore blood flow (in ischemic strokes), stop bleeding (in hemorrhagic strokes), and prevent possible complications.

• What Should Be Done in an Emergency?

If you notice sudden symptoms of stroke in a child, the most important thing you should do is immediately call 112 and request medical help. Remember, time is very valuable in stroke. The earlier the intervention, the less the brain damage may be and the greater the child’s chance of recovery. Try to calm the child, keep them in a comfortable position, and if they are conscious, note the symptoms and when they started.

• Ischemic Stroke Treatment:

In ischemic strokes, the main aim is to reopen the blocked vessel and restore blood flow to the affected region of the brain. For this purpose, in some cases clot-dissolving drugs (thrombolytics) may be used. However, these drugs need to be used within a certain time period and in appropriate patients. In our clinic, emergency clot-removal treatments are also applied in acute stroke cases with interventional radiology methods. In this method, the blocked vessel is reached through a thin catheter and the clot is mechanically removed. In addition, blood-thinning drugs (anticoagulants) may also be used to prevent the formation of new clots.

• Hemorrhagic Stroke Treatment:

In hemorrhagic strokes, the main aim is to stop the bleeding and reduce the pressure in the brain. For this purpose, drugs may be used to control blood pressure. In some cases, surgical intervention may be required to repair the bleeding vessel or evacuate the blood accumulation (hematoma) in the brain.

What May Happen in the Long Term After Stroke (Paralysis) in Children?

The conditions that may arise in the long term after stroke (paralysis) in children may vary depending on the severity of the stroke, which area of the brain it affected, and how early intervention was made. While some children may recover completely, some may have to live with permanent neurological problems.

One of the most common long-term problems seen after stroke is weakness or paralysis on one side of the body (hemiparesis or hemiplegia). This condition may make it difficult for the child to walk, run, hold objects, or perform daily activities.

In addition to motor skill problems, cognitive and behavioral problems may also occur after stroke. These may include attention deficit, memory problems, learning difficulties, reduced problem-solving skills, emotional ups and downs, irritability, or behavioral changes.

Speech and language skills may also be affected by stroke. The child may have difficulty speaking, may not be able to pronounce words correctly, or may have difficulty understanding the speech of others. Difficulty swallowing (dysphagia) may also be seen.

Stroke may also affect the visual pathways and cause double vision, blurred vision, or losses in the visual field. In addition, the risk of seizure (epilepsy) may also increase in children who have had a stroke. After more severe strokes, developmental delays may also be seen in children.

Why Is Rehabilitation Important for Children Who Have Had Stroke (Paralysis)?

Rehabilitation after stroke (paralysis) in children is a vital part of the recovery process. The aim is to restore functions lost as a result of stroke, develop compensatory mechanisms to overcome permanent problems, and ensure that the child achieves the best possible quality of life.

Children’s brains are much more flexible than those of adults, and other regions can take over the functions of damaged areas. Thanks to this feature called “neuroplasticity,” rehabilitation treatments started early can give much better results in children.

The rehabilitation process includes a comprehensive program carried out by a number of specialists. This team may include physical therapy specialists, occupational therapy specialists, speech and language therapists, cognitive therapists, and psychologists.

• Physical Therapy: Focuses on improving the child’s gross motor skills (walking, running, balance), muscle strength, and mobility. It particularly aims to improve areas with paralysis or weakness.
• Occupational Therapy: Helps the child regain fine motor skills (hand-eye coordination, writing, dressing, eating, and daily living activities).
• Speech and Language Therapy: Addresses the child’s problems with speaking, understanding, reading, writing, and swallowing. Work is carried out to improve communication skills.
• Cognitive Therapy: Helps address problems in attention, memory, problem-solving, and other cognitive functions.
• Psychological and Behavioral Therapy: Provides support in coping with emotional and behavioral problems that may arise after stroke.

The rehabilitation program is specially planned according to the child’s individual needs and is regularly evaluated and updated. The education and support of families and caregivers are also an important part of the rehabilitation process. Families should understand their children’s condition, its possible effects, and the rehabilitation process, and should take an active role in this process.

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