Strokes occur when blood supply to a part of the brain is cut off, often in tandem with hypoxic ischemic encephalopathy (HIE), trauma, or both. After three minutes, cells begin to die, releasing cytokines which cause a ripple effect of damage spreading out from the area where blood flow was cut off. This can occur because of traumatic injury or blood clots. Treatment and rehabilitation must be immediate to prevent the spread of damage. Treatment can include IV fluids, blood thinners (to prevent a recurrent stroke), and prompt hypothermia treatment to slow down the damage and help the brain heal.
The risk of pediatric stroke is highest in the newborn period – including during delivery. Very quick medical attention is critical after a stroke in order to help stave off permanent brain damage and conditions such as cerebral palsy. However, even with prompt recognition and management of a stroke, some babies still develop cerebral palsy. Often, cerebral palsy occurs when the baby is in distress and the physician doesn’t deliver her quickly enough by emergency cesarean (C-section) delivery. When a baby is showing signs of distress on the fetal heart monitor, it means she is being deprived of oxygen. A prolonged lack of oxygen in the baby’s brain can cause a brain injury called hypoxic ischemic encephalopathy (HIE), which often causes cerebral palsy.
A stroke occurs when the blood supply to part of the brain is cut off. When brain tissue doesn’t receive adequate oxygen for more than three minutes, the process of cellular injury and death of the tissue begins. There are two types of strokes. A hemorrhagic stroke is when brain vessels rupture from trauma, which can be caused by the use of forceps or vacuum extractors during delivery. An ischemic stroke occurs when brain arteries are blocked by a clot, which can also happen from the use of forceps and vacuum extractors.
A stroke diagnosis that is four or five days late is very harmful for a baby. Treatment of a stroke must be started right away, followed by rehabilitation to help ensure that more brain damage and complications do not occur. Doctors must quickly diagnose a stroke and give treatment to make sure the baby is has optimal circulation and is receiving enough oxygen in the brain. IV fluids and blood thinning medications should typically be given to reduce the risk of the baby having another stroke. When an initial stroke is not recognized or is misdiagnosed, the baby is at a higher risk of having another stroke, which also increases the risk of more brain damage and cerebral palsy.
Strokes can also lead to seizures which are often difficult to recognize and can cause further brain injury. Babies at risk for strokes must be very closely monitored for seizures and other medical problems. Often, the only sign of a seizure is activity on an EEG. Ideally, babies who suffered a stroke should have continuous EEG monitoring. Several neonatal intensive care units (NICUs) around the country have the ability to easily perform continuous EEG monitoring. NICUs that do not have this ability should perform frequent – near continuous – EEG monitoring of a baby who had a stroke or is at risk of having a stroke. The baby should also be closely observed for signs of seizure activity. When seizures are occurring, they are causing injury to the brain, which is why they must be quickly recognized and treated. Seizures put a baby at a high risk of having permanent brain damage and cerebral palsy.