Pediatric Stroke Often Misdiagnosed, Treatment Delayed
(NEW YORK) -- James Finnerty, a 15-year-old rugby player from Parma Heights, Ohio, woke up with a piercing pain in his head one morning last April and, barely able to walk, stumbled to the bathroom vomiting.
The emergency room doctors where Finnerty sought treatment assumed he had a severe migraine and delayed treatment for 25 hours before his mother insisted he be transferred to Cleveland Clinic where they discovered he had suffered a stroke.
The swelling in his brain was so intense that part of his skull was removed to relieve the pressure and, in a second stroke, he lost the use of speech and his limbs.
Almost a year later, after months of physical therapy, Finnerty, now 16, is on the road to recovery, but his experience is a shocking reminder that strokes can strike even the young.
About 3,000 children a year will suffer a stroke -- one of the top 10 causes of death among children, according to Dr. Neil Friedman, a pediatric neurologist at the Cleveland Clinic's Center for Pediatric Neurology, where Finnerty was treated. The majority of these children will live, but will face lingering neurological or cognitive impairment.
"The big difference in pediatric stroke is that there is an almost 100 percent recovery because of the ability of children to adapt and accommodate far better than adults," said Friedman. "When they do survive, they can have six or seven decades of disability."
Finnerty still has some deficits in his comprehension and balance problems, and even though a recent MRI showed his artery has no blockage, he is still at risk for future strokes.
"People tend not to realize that two thirds of children have some residual deficits from stroke and the recurrence rate is 20 percent," said Friedman.
And those residual deficits mean high health care costs. One study Friedman cited showed that the first year of care for a child disabled by stroke is $42,000, not including loss of parents' work.
Stroke is more common in boys than in girls. African Americans are also more vulnerable, even excluding those who have sickle cell anemia, which is associated with stroke risk.
A stroke happens when the blood supply to part of the brain is cut off, resulting in tissue injury and loss of brain function. When tissue is starved of oxygen for more than three minutes, it begins to die.
The two types of strokes are ischemic, when brain arteries are blocked by a clot, and hemorrhagic, when brain arteries rupture from trauma or malformation.
In older children, about one third of all strokes are associated with heart disease. But that was not the case with Finnerty, who had no such history. After taking a hit in a rugby game in 2012, an artery formed a clot in his brain.
"It's a common story," said Friedman. "There was initial damage to the artery, and he did weightlifting and extended the tear and stroked his cerebellum. It wasn't for another 25 hours that he had progressive worsening of the headache that we realized he had a stroke. …The brain was basically being pushed down through an opening in the skull."
Because his diagnosis was delayed to the point of herniation of the brain, the chance of Finnerty dying was "really high," according to Friedman.
Quick medical attention is critical when treating stroke, and yet the average delay in diagnosis of pediatric cases is 28 hours, wasting precious time when a child could get life-saving medication.
Although stroke can occur anytime during childhood, the risk is highest in the late stages of pregnancy and the early newborn period, occurring in about 1 in 3,000 live births. An estimated 40 to 50 percent of all strokes in children happen in the first year of life.
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