From time to time, Atlanta Hyperbaric gets a child referred for hyperbaric oxygen therapy who has had a stroke. Although most of our stroke patients are adults, and older adults at that, it seems like awareness of stroke in children is increasing. Not long ago, the American Heart Associations issued guidelines for the diagnosis and treatment of childhood stroke. These guidelines emphasize the differences in pediatric and adult strokes. For example, most of the kids with stroke have congenital heart disease or sickle cell disease. Most adults have atherosclerosis. Many of the kids have had perinatal strokes, that is, strokes just before, during or shortly after birth, like our most recent child referred to Atlanta Hyperbaric. Children with stroke often present with seizures, whereas adults do so infrequently. Clot busting drugs like TPA have not been studied in children because it is so rare to diagnose a child within three hours of the onset of stroke.
Now it turns out that the incidence of childhood stroke may be more frequent than once believed. A University of California group took a look at Kaiser Permanente records of more than two million children to determine the incidence of stroke in this population. Stroke is still pretty rare in children, 2.4 per 100,000 person-years, but these finding are roughly double the incidence previously reported. Because the authors searched radiology reports as well as discharge diagnoses, they were able to confirm a lot more cases.
These data say nothing about whether the incidence of stroke in children is increasing or that diagnosis is become more accurate. What we can say, for certain, is that childhood stroke is being recognized more and more.
I believe that hyperbaric oxygen therapy can be of particular benefit to children who have had strokes. For example, I have seen striking improvement in seizure control in cerebral palsy patients treated with hyperbaric oxygen and would think the same would be true in children with strokes. Of course, like the cerebral palsy patients, children with stroke have a whole lifetime in front of them.