New guidelines to help child stroke victims

Aimee and Matt Dean’s daughter Mackenzie suffered a stroke affecting the right side of her brain in August 2014. Aimee recalls noticing that Mackenzie’s left side looked ‘droopy’, that her speech was slurred and her left arm had gone limp.

Mackenzie’s quick-acting parents called an ambulance and she was rushed to the Royal Children’s Hospital, where tests confirmed that she had suffered from a stroke, although the cause was not identified. Aimee said, “At the time I felt like an overcautious parent, but we instinctively knew that things just weren’t right with Mackenzie.”

Mackenzie spent around a month in hospital learning how to crawl, talk and walk again. She is now five years old and has made a full recovery, but not all stroke victims are as fortunate.

Approximately 300 babies and children are diagnosed with a stroke in Australia each year. More than half of the children that survive have long-term disabilities that they carry for their lifetime at great cost to themselves, their families and the healthcare system — which is why new clinical guidelines to be rolled out across the country are so important.

Developed by doctors from the Royal Children’s Hospital and the Murdoch Children’s Research Institute, and endorsed by The Stroke Foundation and the Australian and New Zealand Child Neurology Society, the clinical guidelines will speed up diagnosis when time is critical, to minimise brain injury and improve recovery.

The causes of stroke are different in children and therefore adult care pathways need to be modified for children. There is good community awareness of stroke and there are systems in place to rapidly identify and treat stroke in adults. In contrast, children often wait more than a day for stroke diagnosis and as a consequence may miss the window for life-changing interventions to minimise brain injury and improve recovery.

Some key recommendations include:

• Recognising presenting symptoms that require investigation for stroke;
• The importance of urgent MRI using child-specific imaging protocols for an accurate stroke diagnosis;
• Elements of service necessary for hospitals to qualify as a Primary Paediatric Stroke Centre;
• How to acutely manage symptoms and identify those children eligible for treatment or requiring surgical interventions.

The guideline also includes a quick reference guide for physicians.

Associate Professor Mark Mackay — paediatric neurologist, director of the Royal Children’s Stroke Program and researcher with the Murdoch Children’s Research Institute — chaired the Australian Childhood Stroke Advisory Committee (ACSAC), which included specialists representing each of Australia’s tertiary paediatric hospitals. The ACSAC members volunteered their time and expertise to ensure that these important guidelines are of the highest international quality and can be implemented across the county.

“We believe that implementing a standardised approach to diagnosis and management will ensure children are not being left behind in the advances in stroke care which have transformed outcomes for adults,” said Dr Tanya Medley from the Murdoch Children’s Research Institute, who coordinated the development of the guidelines.

The full guidelines will be published in the International Journal of Stroke.

Image caption: Thanks to her parents’ quick thinking, Mackenzie Dean made a full recovery from her stroke. Image ©Murdoch Children’s Research Institute/Georgie Wilson.