Every year in France, 130 to 150 000 people are a cerebral vascular accident (stroke). Among them, 500 to 1,000 were less than 16 years old. No matter the age, rehabilitation must begin early and continue throughout course to limit the risk of sequelae.
Because of its relative rarity, childhood stroke is less well known than that of the adult, including health professionals. His diagnosis is sometimes late and its costly and difficult to support. Families and children often see their daily routine upset.
STROKE in children and infants
Cerebral vascular accident (stroke) is causing a disruption of blood flow, and therefore oxygen supply, in the brain. It may be associated with the blockage of a vessel (ischemic stroke, also known as cerebral infarction) or break (hemorrhagic stroke that matches the brain bleeding). Its support is an emergency, the risk of sequelae is linked to the time during which neurons have been deprived of oxygen.
Every year in France, 130 to 150 000 people are a stroke. If the elderly are the most affected (three quarters of strokes affect over 65 years), children and newborns are not spared. They constitute about 0.6 per cent of cases of stroke, 500 to 1,000 new annual cases. Specialists distinguish stroke “of the child and older child”, which has two peaks of onset, to 2-3 years then 10-11 years, stroke “perinatal” that occurs before birth or in the newborn.
The child, a stroke to the multiple causes stroke
While adult stroke is 80% more often due toatherosclerosis or heart disease, ischemic, stroke of the child is characterized by its causes, multiple and varied: “blood disease (sickle cell anemia, clotting disorder…) or the heart, abnormalities of the vessels of the brain (Moya Moya disease), local (Arteritis, aneurysm…) malformation, injury, infection, tumor… There are more than a dozen!”, note the Pr Marc Tardieu, Pediatric neurologist, he head of the Department of neuropediatrics at Hospital London (AP – HP), Paris.”
The causes must be systematically sought to guide immediate but also long-term support. Diseases require a follow-up or a lifelong treatment to prevent recurrences.
Childhood stroke: more or less talking symptoms
To support the stroke, still should have spotted it. This children’s signs similar to those of the adult: paralysis or a decrease in the sensitivity of a member or of one side of the body or face, speech disorders, headaches, sometimes a coma… that appear suddenly, often in the morning. In young children, there is mainly motor problems, disorders of the speech and the sensitivity that can be difficult to spot. The newborn can Cliffhanger and present paralysis. Between 5 and 10% of children die in acute phase.
However, perinatal stroke may also be taken during pregnancy or do not cause marked symptoms. During the first weeks, the newborn seems quite normal as explains Véronique, co-founder of the stroke of the child association: “A three month, Jean-Noah has been catching anything on the right side. I got worried but doctors had response at all. One even told me that it would be left-handed. At five months, he was finally able move a brain MRI which showed the scar of a perinatal stroke. Some children are diagnosed just two years!”.” A delay in diagnosis which has an impact on the rehabilitation that it must begin quickly to limit the consequences.
The older children follow a route similar to that of adults, with a stay in rehabilitation and/or day if necessary and the continuation of rehabilitation to professionals. The younger more quickly found their parents. Their rehabilitation, which requires special skills, is a service of neuropediatrics, through specialized agencies or with liberals.
Eyden was a stroke perinatal overnight, immediately detected. It has benefited from sessions of occupational therapy at the age of two month and speech therapy to eight months. Now 18 months old, it has virtually no engine problem. But his mother, Viviane, is not for all fully reassured: “we work on a daily basis, while trying to meet his child’s life. However, you never know if it is too, or not enough, the limits are difficult to fix”.
To organize on the long term
Pr Tardieu confirms: “stroke of the child requires support long-term.” Families are organized based on the centres and specialists available, financial resources and organization, progress of the child, of his possible weariness. When the physical therapy makes more progress, it may be interesting to replace it with a sport or leisure activity”.
Many parents stop to work, reducing their income, while movements related to rehabilitation and care increase their spending. And Véronique to explain: “of occupational therapy and occupational therapy sessions are not reimbursed. Physiotherapy Yes, but not the transport to go less than the nearest specialist. However, very few physical therapists have the skills and equipment to care for children”.” The financial assistance provided by the departmental houses for persons with disabilities (MDPH) is variable depending on the departments and often insufficient.
Difficult to predict effects
Almost five years, Jean Noah always ignores his right hand. “It does not, use it even to hold a bag note Véronique. On the other hand, his body grew up a little differently on both sides. It can be difficult for some parents, but today, I can’t imagine my child otherwise. I was also afraid that it does not work. It just took a little more time and the help of a splint. At the engine level, I make him confidence!”.
Like many parents, Véronique concerned now about the risk ofepilepsy, much greater in children than in adults, and the cognitive consequences of stroke that can occur on the later. Viviane, who found her daughter much more capricious than its elders, does not fail to wonder: “what is stroke? His character? Or the fact that it is the small last?”
“Stroke long-term consequences are just as diverse as those observed in adults, note the Pr Tardieu. In the youngest, they are essentially driving, sometimes cognitive, difficult to predict. The great child disorders depend on the affected area”.” More than two-thirds of the children are more or less important sequelae.