Brain stroke in children is considered to be rare. But an ongoing study by a city hospital has revealed that it may not be that uncommon after all. Worse, many cases may be going undiagnosed or wrongly treated.
Around eight months ago, the Kokilaben Dhirubhai Ambani Hospital, Andheri, initiated a study to track patients under 18 coming for stroke treatment. To their surprise, they clocked 16 patients—an average of two a month. Annually, 1.5 million adult Indians suffer strokes, but the number of kid sufferers is unknown. The study found none of the patients got diagnosed or received correct treatment within the first four hours, considered 'golden' for best treatment outcome, of suffering a stroke. A few were admitted to nursing homes and tertiary-care hospitals, which did not perform correct diagnoses. Most children got the appropriate treatment after 12-72 hours were lost.
"Even in a city like Mumbai, awareness about stroke in children remains shockingly low. Paediatricians and physicians often misread the signs for something else and children lose out on correct, timely treatment," said Dr Pradnya Gadgil, paediatric neurologist at KDAH. She said the aim of the study is to evolve a treatment protocol, as currently it is extrapolated from adult stroke management.
"For Indian children suffering strokes, a unique reason is trauma or a minor injury caused by, say, a fall. It is common in children below three here and is rarely seen anywhere else in the world," said Dr Vrajesh Udani, paediatric neurologist at PD Hinduja Hospital, Mahim, which treats two or three stroke cases among children a month. Udani said the incidence of pediatric stroke in India may be slightly higher than in the West
Stroke occurs when blood supply to the brain is interrupted by a clot in an artery, or by the bursting of a blood vessel inside or outside the brain. Lack of oxygen (supplied by blood) even for a few seconds can disrupt the brain's functioning and permanently damage bodily movements the affected brain area controls.
The youngest child to get stroke was a one-year-old and the oldest was 17. The baby was diagnosed with an underlying cardiac condition, but the cause of stroke in the teen could not be established. In all, children have better chances of recovering from a stroke. The mortality rate among adult sufferers is 30%. "Even if mortality among child sufferers is low, morbidity (the number of people who have a disease in a particular population) can be significantly high," said paediatric neurologist Dr Shekhar Patil, who consults with Jupiter Hospital, Thane.
In the KDAH study, out of the 16 children, four (25%) went home with longstanding neurological deficits. Gadgil said two children had weakness in one side of the body and had difficulty with walking, while the others had facial drooping, loss of movement in hands and palms, and inability to perform motor tasks like buttoning a shirt. "These problems can be resolved with neuro rehabilitation. Children have brains like plastic, easy to mould."
City neurologists believe the scenario is getting better. "We are diagnosing the condition faster. Also, we have a better understanding of the reasons," said Dr Sangeeta Rawat, head of neurology, KEM Hospital, Parel. Artery problems, heart conditions, congential malfunction of blood vessels and infectious diseases like tuberculosis are primarily responsible for stroke in the paediatric age-group, she said.
Treatment remains the biggest point of contention as some of the most effective methods to treat stroke cannot be used on small children. "The methods include thrombolysis (bursting clot with medicine) and other invasive approaches. The world over, stroke management for children is still evolving," said Gadgil.
