Abusive Head Trauma or Pediatric Stroke?
Abusive Head Trauma is a challenging diagnosis that should be evaluated by a medical professional with the collaboration of other disciplines. The presentation of a lethargic child, with mental status changes, vomiting, diarrhea, irritability, seizure activity, sleepiness and/or drowsiness does not always point to child abuse. Individual clinical presentations/diagnoses should not immediately lead the clinical evaluator to the diagnosis of Abuse Head Trauma or child abuse.
Cerebrovascular ischemia, also known as a stroke, is caused by an interruption of the normal blood flow to the brain caused by either a blockage or a rupture of the blood vessels. There are only two causes of stroke: blockage and bleeding. In a stroke caused by blockage, diagnostic radiology results can show signs of thrombosis (blood clot), which can indicate an ischemic stroke. This means a blood clot is blocking the blood flow to brain resulting in a stroke. In a bleeding stroke, this occurs when a blood vessel in the brain ruptures and bleeds into the brain itself.
Pediatric stroke is not a common occurrence and can lead to significant morbidity and mortality. Roughly 10 to 25% of children with a stroke will die, 25% of children will experience recurrence and up to 66% will have persistent neurological defects or develop subsequent seizure disorders, learning or developmental problems (Tsze, 2011). Children can present with a change in mental status, headache, seizure activity, vomiting, somnolence and fever.
Some of the causes for pediatric stroke include, but are not limited to:
- Congenital issues
- Volume depletion or systemic hypotension
- Infection such as meningitis
- Cardiac issues
- Bleeding diathesis
- Down Syndrome
Titomanlio, L. e. (2013, February). Pediatric Ischemic Stroke: Acute Management and Areas of Research . Retrieved from Journal of Pediatrics: http://www.jpeds.com/article/S0022-3476(12)01067-0/abstract
Tsze, D. a. (2011, December 27). Pediatric Stroke: A Review. Retrieved from National Institutes of Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3255104/