9 year old stroke victim survives due to treatment within “The Golden Period”

New Delhi: Lifestyle diseases are increasing in India, which has also led to increase in stroke cases. But while awareness about stroke is also increasing, stroke in a child is practically unheard of. But on a normal morning of 1st May 2018, this is exactly what happened. A nine-year-old girl suffered an acute arterial ischemic stroke while she was in school. But thanks to the quick thinking of her teachers and parents, not only was her life saved, but she was also prevented from becoming disabled for the rest of her life. Their promptness in seeking help within the ‘Golden Period’ saved their daughter immense trauma.

The patient’s father narrated, “She was normal when she went to school in the morning. But her teacher noticed something odd about her behaviour. She was not able to lift bag from her left hand and not able to put weight on her left leg. Suddenly, she lost her coordination and fell down. The teacher, instead of giving her medicine and telling her to lie down, immediately called me. I rushed my little girl to a local hospital where MRI revealed acute infarct of right fronto-parietal region. In layman’s terms, it was cerebral infarction which happens with the narrowing or blockage of the arteries and when specific areas of the brain stops receiving blood supply.”

For further treatment, the family decided to pursue treatment from Indraprastha Apollo Hospitals for their success in multi-speciality treatment approach and shifted her immediately.

Dr Priyadarshini Pal Singh, Head of Department – Emergency, Indraprastha Apollo Hospitals, New Delhi said, “The Golden period refers to the brief window of about 4 hours during which if a person is treated for stroke, their chances of survival and recovery increase considerably. When the child was admitted, she was presenting the symptoms of acute onset of weakness of left upper and lower limbs. MRI and MR Angiogram were done again to know the cause and extent of problem. The diagnosis was undeniable. At an age when most children don’t even know the meaning of stroke, this nine year old little girl was a victim to acute arterial ischemic stroke.”

“Diagnostic investigations showed non-haemorrhagic acute infarct in right subcortical and periventricular white matter region of centrum semi-ovale. MRI suggested complete cut off of right MCA (Middle Cerebral Artery), just after its origin with non-visualization of distal MCA. Management of her stroke attack was started immediately as per protocol,” explained Dr Harsh Rastogi, Senior Consultant, Radiologist, Indraprastha Apollo Hospitals.

The child was shifted to paediatric ICU (PICU) where her complete blood profile was done. Dr V.B. Gupta, Senior Consultant, Paediatric Neurologist, Indraprastha Apollo Hospitals stated, “Her PT/aPTT were normal, as were her platelet count, coagulation profile, plasma fibrinogen. Abnormal Homocysteine level were found which indicated the risk of developing stroke. Echo was suggestive of small PFO (patent foramen ovale) which is a hole in the heart. We decided to start the treatment with TPA in therapeutic doses over one hour. Passive limb physiotherapy was started to maintain the blood flow.”

Slowly, the child became stable with flickering movement and slight pain in the left lower limb.

Dr V.B. Gupta further stated, “The deciding factor in this case was that the parents of the children realised the gravity of the situation and sought help at a multi-speciality hospital equipped to handle such complex cases. Stroke in children is quite rare, and for many people quite unheard of. This is why people don’t connect the dots when the symptoms of stroke show up in children. Many children, who can be saved, end up facing disability for the rest of their life because their guardians are not aware and don’t seek help.”

Her parents were advised to continue with the prescribed medication and passive physiotherapy at home. Continued follow ups have also been recommended to ensure good health of the child.

“While I was aware that time is an important factor in seeking help for stroke, I did not know about the golden period of 4 hours. Today, my child is on her way to recovery. Her left hand is 90% recovered and her left foot is about 30% recovered. We are concentrating on her physiotherapy which has been of immense help. She is being administered blood thinners within a period of 10 hours every day. It was a shocking and traumatic experience for me and my family. I am grateful that my child will be okay, but I want to understand the root cause of why stroke occurred in such a young child,” the father of the nine-year old girl said.

The child had a beaming smile on her face when she was discharged from the hospital. Her father commented, “She is a positive child, despite going through this distressing event. It is only when other people make insensitive comments that her morale goes down. But we keep counselling her because we know that she is going to be alright.”