Stroke
Lesson Objectives
By the end of this lesson, learners should be able to:
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Define paediatric stroke and differentiate between ischemic and haemorrhagic types.
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Identify risk factors and common causes in Zambian children.
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Recognize the clinical signs and symptoms of paediatric stroke.
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Outline the investigations required to determine type and underlying cause.
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Describe stepwise management of ischemic and haemorrhagic strokes.
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Plan long-term rehabilitation and supportive care for stroke survivors.
Description
Paediatric stroke is a focal neurological deficit resulting from underlying vascular pathology. It can be ischemic (arterial or venous occlusion) or haemorrhagic (intracerebral or subarachnoid bleeding).
In Zambia, the most common cause is sickle cell anaemia. Prompt recognition and management are essential to prevent permanent neurological disability and mortality.
Clinical Features
| Symptom Category | Signs and Symptoms |
|---|---|
| Motor | Hemiparesis, weakness or paralysis of limbs |
| Cranial Nerves | Cranial nerve palsies |
| Neurological | Seizures (especially neonates/infants), deteriorating consciousness |
| General / Systemic | Headache, nausea, vomiting |
Investigations
| Test Type | Purpose |
|---|---|
| Full Blood Count & Differential | Detect infection or anemia |
| ESR | Inflammatory marker |
| Random Blood Sugar | Rule out hypoglycaemia |
| Sickling Test | Detect sickle cell disease |
| Clotting Profile & Coagulation | Assess protein C/S, antithrombin III deficiencies, platelet function |
| Electrolytes | Monitor sodium, potassium, etc. daily until stable |
| Blood, Urine, CSF cultures | If febrile (withhold LP if raised ICP suspected) |
| Neuroimaging | MRI preferred; angiography for vascular assessment |
Management: Ischemic Stroke
| Step | Action |
|---|---|
| Emergent Care | ABCDE stabilization, airway protection, NGT and catheter placement, PICU admission if available |
| Monitoring | BP (50th–95th percentile, permissible 20% above 95th), pulse, RR, GCS, RBS, temperature, signs of raised ICP |
| Infection Control | Treat suspected CNS infections as per protocol |
| Cause-specific Treatment | Exchange transfusion or blood transfusion in SCD; anticoagulants in prothrombotic disorders |
| Supportive Care | Oxygen as needed, maintain normothermia, fluid management |
Management: Haemorrhagic Stroke
| Step | Action |
|---|---|
| Emergent Care | ABCDE stabilization, NGT and catheter placement, PICU admission if available |
| Monitoring | BP (maintain normal), pulse, RR, GCS, RBS, temperature, signs of raised ICP |
| Neurological Surveillance | Watch for extension of haematoma, herniation, hydrocephalus |
| Supportive Care | Isotonic IV fluids for at least 24 hours, manage raised ICP if present, treat acute seizures |
| Cause-specific Treatment | Replace clotting factors, platelet transfusion for thrombocytopenia, MRI/MRA to detect vascular malformations, neurosurgical intervention if indicated |
Rehabilitation and Supportive Care
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Physiotherapy for motor recovery
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Speech therapy for communication deficits
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Occupational therapy as needed
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Psychological support for patient and family
Summary
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Paediatric stroke can be ischemic or haemorrhagic; sickle cell disease is the most common cause in Zambia.
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Presenting signs include hemiparesis, cranial nerve deficits, seizures, headache, and altered consciousness.
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Emergent ABCDE stabilization, monitoring, and early PICU care are crucial.
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Treatment is guided by stroke type, underlying cause, and complication management.
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Rehabilitation and supportive care are essential for long-term outcomes.