Children who have sickle cell are over 300 times at risk of having a stroke than any other child without sickle cell anaemia.
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 ischemic stroke)
A bleed in or around the brain from a burst blood vessel (also known as a haemorrhagic stroke).
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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?
Stroke in children is more subtle and symptoms may occur over a period of time. If you are unsure and its not pain, get your child checked out in A&E and ensure neurological observations are carried out each time.
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 1990’s, 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.
The concise key recommendations guide contains 83 key recommendations identified by the RCPCH Stroke in Childhood GDG, which, if followed, will enhance the quality of stroke care in children and young people.
These recommendations have been extracted from the clinical guideline, which contains over 250 individual recommendations covering the diagnosis, management and rehabilitation of stroke in children and young people.
It is recommended that the concise key recommendations guide should not be read in isolation, and individuals should always consider the guideline in full.
Key recommendations (PDF, 9 pages, 114KB)
Full recommendations (PDF, 25 pages, 220KB)
The information is designed to help the reader understand what a stroke is, why strokes occur, and how children and young people affected by stroke should be treated and cared for. It describes the usual journey from diagnosis to rehabilitation that a child or young person will follow after a stroke and will outline what you should expect at each stage of treatment and rehabilitation.