Risk Factors

Childhood stroke deaths are poorly understood, since it is not possible to take the risk factors important for strokes in adults (such as high blood pressure, poor diet, or diabetes) and apply them to children. Experts suspect an unknown genetic predisposition may play a role in these deaths. Hormonal differences may be a factor in the higher stroke rates in boys.

Known risk factors for childhood strokes caused by bleeding include brain tumors or vascular malformations, hemophilia, cancer, and sickle-cell disease. Childhood strokes caused by blockages (ischemic strokes) have also been linked to sickle-cell disease and cancer. Risk factors that contribute to ischemic strokes include meningitis, encephalitis, congenital heart disease, and certain blood clotting disorders.

Hemorrhagic strokes showed the steepest drop in death rates in the past 20 years: Childhood stroke deaths from subarachnoid hemorrhagic strokes (bleeding into the space between the brain and the skull) dropped by 79 percent, while strokes from intracerebral hemorrhages (bursting of a defective brain vessel) declined by 54 percent.

The declines were not as dramatic for deaths from ischemic stroke, which results from a blood clot that blocks blood flow to the brain. Ischemic stroke deaths declined 19 percent in the same time period.

Unfortunately, black children and boys have much higher risks for dying of strokes for some unknown reason. Black children were more than twice as likely to die from strokes caused by intracerebral hemorrhage, and about 75 percent more likely to die from ischemic strokes or sub-arachnoid hemorrhage. No factors (such as sickle-cell disease, which is more common in blacks than whites) fully accounted for excess stroke deaths. Boys of all races were also 30 percent more likely to die from subarachnoid hemorrhage and 21 percent more likely to die from intracere-bral hemorrhage than girls.

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