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Don't overlook cases of pediatric stroke in your ED
Many cases go undetected
More than 3,200 children have "brain attacks" each year, but these often go unrecognized in the ED, since nurses don't suspect stroke in children, says Lori Jordan, MD, a pediatric neurologist who specializes in stroke at the Baltimore-based Johns Hopkins Children's Center. Strokes in children may occur even more often than brain tumors, Jordan adds.
"But unlike cancer, sadly, strokes in children are sometimes not recognized and treated, or at least not as early as they should be," she says. "Half of these cases end up with permanent neurological damage."
Arterial dissection, which often is trauma-related, causes one-fourth of all strokes in children, says Jordan. Other common causes of stroke in children include congenital heart disease and sickle cell disease, and rarer causes include blood-clotting disorders and abnormalities of the blood vessels, she adds. "We have seen several cases of pediatric stroke in our ED over the last year."
Strokes may occur after a traumatic injury to arteries in the neck or spine, commonly caused by whiplash sustained during a car accident or injuries from high-contact sports, says Jordan. "Carotid or vertebral artery injury can lead to small tears, which generate blood clots that travel to the brain," she explains.
A common symptom of trauma-related pediatric stroke is neck pain on one side, accompanied by a one-sided headache, possibly with numbness and weakness on that side of the body, says Jordan.
If a child or young adult complains of weakness and/or numbness on one side of the body, often involving the face and arm — or face, arm, and leg — consider stroke as one possibility, advises Jordan. "Specifically, the patient should be asked about trauma to their neck, neck pain, and unilateral headache," she says. Pupillary size should be checked, Jordan says. "Asymmetry is a rare but worrisome sign," she says.
Take these steps if you suspect pediatric stroke, says Jordan:
Don't miss signs at triage
ED triage nurses must recognize signs and symptoms of stroke in children, and they must be familiar with the anatomic and physiologic differences of children, says Mary Ellen Wilson, RN, BSN, CEN, nurse clinician at the pediatric ED at Johns Hopkins Children's Center. Signs such as hemiparesis, impaired speech, impaired comprehension, or neurologic deficits may be difficult to assess in the young child who is unable developmentally to communicate or follow commands, says Wilson.
For example, a newborn infant may exhibit seizure activity with lip smacking or eye deviation and fluttering, says Wilson. "The triage nurse is challenged to recognize the subtle cues and abnormal assessment findings, since early recognition and treatment are critical in optimizing outcomes," she says.
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