Childhood Stroke

Children who have sickle cell are over 300 times at risk of having a stroke than any other child.

What is a stroke?

A stroke is a brain attack. It happens when the blood supply to the brain is cut off due to:

• A clot blocking the flow of blood to the brain (also known as an ischaemic stroke)
• A bleed in or around the brain from a burst blood vessel (also known as a haemorrhagic stroke).

‘Silent’ stroke

About 17% of children with SCD also have ‘silent infarcts’ – strokes with no obvious symptoms at the time but which can lead to cognitive impairment (such as diminished memory, attention, emotion, concentration or reason) in the long term.

In the case of ‘silent’ strokes, because there are no obvious signs, it is important to look out for possible long term changes in children with SCD. These could include changes in behaviour, concentration, memory, fatigue levels or handwriting.

Recovery is possible but may be slow and can vary from child to child.

What are the signs of a stroke?

It is important for you to know what the signs of a stroke are.

Here is a simple reminder of the FAST test:

• Facial weakness – can the person smile? Has their mouth or eye drooped?
• Arm weakness – can the person raise both arms?
• Speech problems – can the person speak clearly and understand what you say? Time to call 999.

How can the risk of stroke be reduced?

It is recommended that children with Sickle cell anaemia between the ages of 2 and at least 16, should be screened for stroke on an annual basis using an ultrasound test called a Transcranial Doppler scan (TCD). TCD is a device that uses painless and harmless ultrasound (sound waves) to find areas of abnormal blood flow in the brain’s blood vessels which could indicate a higher risk of stroke.

A large American study performed in the 1990s, called the Stroke Prevention Trial in Sickle Cell Anaemia, showed that children with abnormal TCD who receive regular monthly blood transfusions have a 90% lower risk of stroke.

Children with abnormal TCD should be offered long term blood transfusions, although, as this is linked to iron overload (excess build up of iron in the body), medical decisions will need to be made on a case-by-case basis.