The Misdiagnosing of Pediatric Strokes

The Misdiagnosing of Pediatric Strokes

Jayda Moore, Reporter

The evening of February 4th, 2010, had been like any other for the Moore family. This was until 6-year-old Jawzlyn had come to Nicole, her mother, complaining about a headache. Nicole had been busy with dinner so she told Jawzlyn to go lay in bed and that she would be up in a minute. However, as Jawzlyn reached the first flight of stairs, Nicole reported that she had crumpled into herself, moaning in pain. Nicole had assumed it was a migraine, so she helped Jawzlyn to the bathroom where she had intended to give her a bath; however, when Jawzlyn tried to stand on her own, she was unable to move her legs to do so, and this is when Nicole decided to call 911.

Once looked at in the ER, Jawzlyn had been diagnosed to have suffered from a seizure with Todd’s paralysis, and was sent home. 12 hours later, it was the next morning and Jawzlyn still showed no improvement. Nicole described Jawzlyn to still be out of control of her body and even reported “she was still slumped over on one side and when getting her to the doctors I had to use a stroller just to move her.”

So she was brought to Foursight Family Physicians where she was looked at by a neurologist, and given an MRI. The neurologist recommended they be transferred over to the Children’s Hospital in Aurora, Colorado.

By 5pm, Jawzlyn arrived and was officially diagnosed with a pediatric stroke and was given heparin to get rid of the clot in her brain, after which doctors started rehabilitation. This totaled to be around 24 hours before Jawzlyn had a correct diagnosis and started treatment.

It took 3 weeks for Jawzlyn to be discharged from the hospital. Now about 13 years later, Jawzlyn lives her life as normally as she can. However, because of her late diagnosis, she was left with permanent brain damage resulting in Ataxia. This is a light form of cerebral palsy that has made it extremely difficult to control her left side. Specifically, her left arm and leg, which constantly jerk and shake as if they have a mind of their own. When interviewed about the effects of her stroke, Jawzlyn replied “I’m lucky I can even walk” and she also explained that she finds it difficult to do daily activities; ones that usually involve using two hands or extensive physical labor.

So the question is why didn’t Jawzlyn get a proper diagnosis the first time she had visited the hospital? Well, the reality is that people are unaware that children can even have strokes and it is important to inform people about Pediatric strokes in hopes to get children the help they need in such cases in order to prevent permanent damage.

What is Pediatric stroke? And how common is it?
A pediatric stroke is a very rare condition that affects every 4000 newborns and every 2,000 children between the ages 1-18 each year. A stroke is a type of cerebrovascular disorder. In fact, this is one of the top 10 causes of death in children. It also will most likely cause neurologic disability, with a risk of permanent damage, much like what happened to Jawzlyn after she recovered.
According to the National Library of Medicine, 19 out of 45 children received incorrect diagnosis for 15 hours and up to 3 months after they suffered the stroke. This had ensured permanent damage and for some even death.

Symptoms of a stroke. Adults vs Children
Children who suffer strokes have been recorded to have these symptoms-
Difficulty talking
Numbnessor tingling
Neck pain or stiffness
Sudden collapse
Sudden loss of consciousness or lethargic/unresponsive
Sudden loss of movement or weakness in the face, arms, and legs
Sudden onset of headache
Out of these listed, Jawzlyn and her parents reported that she had suffered from sudden onset of headache, sudden collapse, sudden loss of movement or weakness in the face, arms, and legs, and she had become lethargic.

Adults who have had stroke have reported their symptoms to be the following:
Sudden numbness, and weakness in the face, arms, and legs
Sudden confusion and difficulty speaking
Sudden severe headache
Nausea or vomiting

Admittedly these are pretty similar symptoms leaving really no reason to believe a child couldn’t have a stroke and no reason for a child to go misdiagnosed for so long. I also asked the Moore family if they believe their situation could have been handled better. Jawzlyn had said yes she thinks it could have been handled way better than it was, but her parents, Daniel and Nicole believed that there was so little to be done because the doctors had no Idea what caused her stroke in the first place, so it was out of their hands.

However, this raises the question: is there more to be researched about pediatric strokes? And if there was more research done on pediatric stroke and the different symptoms, causes, and effects, would it help people like Jawzlyn and hopefully bring more attention to children who have been, and could be in her situation one day.

Unfortunately, there is no good reason that pediatric stroke isn’t considered earlier on. It is a misconception in society that stroke only occurs in older people. One possibility is that doctors could also be influenced by social norms. In other words, doctors could diagnose based on what is most common instead of looking into other options. A study done by Rafay and colleagues, it was found that most of the time children get misdiagnosed with other issues such as seizures, headache and hemiparesis. This is due to the symptoms being so similar that if time and effort isn’t put into the diagnosis, it is easy to get incorrect. One way to help improve this issue is to have doctors and nurses study the differences between children who suffer from strokes, compared to children who suffer from seizures, headaches, and hemiparesis. They could hopefully apply this new information to their work and are able to properly diagnose their young patients. Another way is to educate society so people are more inclined to think about the possibility of children having strokes and doctors can think twice about how to handle a patient with these symptoms by taking the correct steps to ensure that they are 100% correct with their diagnosis.

Jawzlyn and her family say they wish there could be something done about the problem, but it’s just too unknown and misunderstood that there is little that can be changed and all that people can do is inform people about the problem. So the moral of this is to understand that it is a possibility for children to have strokes, and there needs to be change made, whether it be more research or more careful diagnosis or both,to hopefully bring more light on this matter and help the young victims of strokes.