Nashville, TN (written by Tom Wilemon/The Tennessean) -- Sophia Salveson could sing only with her eyes after the stroke.
The 19-year-old college freshman, whose voice had soared in high school musicals, lost the ability to speak and to move the right side of her body March 1. The stroke was so massive that doctors had to remove part of her skull to relieve brain swelling.
Sarah Heacock was luckier. The 17-year-old competitive swimmer quickly recovered from her stroke in September.
Six-year-old Jacob Schettler's experience falls somewhere in between. After two brain surgeries since his October stroke, he is still in therapy working toward the full recovery of his right side.
People generally associate strokes with older adults, yet 5 percent to 10 percent of cases occur in adolescents and young adults, according to the U.S. Centers for Disease Control and Prevention. About three out of every 100,000 children will suffer a stroke.
Childhood obesity is driving this trend. A study of stroke hospitalizations of children and young adults from 1995 to 2008, published last year in the Annals of Neurology, concluded that "urgent public health initiatives are needed" to reverse unhealthy behaviors in young people. It found that nearly a third of 15- to 34-year-old stroke victims had high blood pressure and more than a quarter of them had diabetes.
But that doesn't mean slender, active teenagers can't have strokes. They occur almost as commonly as brain tumors in young people, but many parents do not realize this and often fail to recognize the warning signs.
Heacock's mother, a physical therapist, delayed taking her to an emergency room.
"I would look at her and think, 'Well, it looks like a brain stem stroke.' Then I would say to myself, 'Nah -- it can't be,'" Nancy Darr said.
On average, people get a child who has suffered a stroke to a hospital two to three days after the first symptom, compared with 12 hours to one day for adults, according to the National Stroke Association.
Fast treatment vital
Heacock initially experienced dizziness and vision problems while doing homework on a computer. Since she had a bad cold at the time, her mother thought she was getting an inner ear infection. Darr slept with her daughter that night and noticed the next morning that her right and left eye movements were out of sequence. That's when she began pondering, then discounting, the possibility of a stroke.
Darr took Heacock to her pediatrician, who sent her to Vanderbilt children's hospital, which opened a pediatric neurovascular center to better focus on pediatric strokes. Dr. Lori Jordan, the hospital neurologist who treated Heacock, said half or more of the teenagers who have strokes aren't as lucky as this girl.
"There are different estimates, but 50 percent to 80 percent of children who have a stroke will have a permanent neurological deficit," Jordan said. "The severity of that deficit varies."
Rapid treatment is important because in some stroke cases, early intervention can limit brain loss.
Salveson never got that opportunity because her stroke was sudden and massive.
"She had no warning signs, and with no understandable cause, you cannot prevent it from happening," said her mother, Marabeth Quin.
Boys more at risk
Although Salveson and Heacock happen to be female, boys are actually more at risk than girls, Jordan said. African-American children are also at greater risk. Jordan and Dr. Robert Singer, a neurosurgeon, came up with the idea for an integrated unit dedicated to neurovascular issues.
"We think of brain tumors all the time -- when a child has a headache, when a child looks funny," Jordan said. "We don't think about stroke. It never enters the mind."
The incidence rate is higher for newborns, about 25 per 100,000, she said.
"Birth is such a stressful process," Jordan said. "Your whole body is changing at that time."
In older children, causes can range from sickle cell anemia to congenital conditions.
Signs of trouble
The most common symptoms of a stroke are weakness on one side, facial drooping on one side, speech impairment, double vision or loss of vision. Heacock had a memory and vision problem while doing her homework.
"I could not remember the password, and I couldn't see the keys to the computer," Heacock said.
When she stumbled into a dresser, her mother heard the sound and ran upstairs. But at that point, the stroke symptoms were not readily apparent.
Jordan said sometimes a "stroke in evolution" occurs and offers a window for preventing additional brain injury. For instance, a clot-bursting drug can be given, but to be effective, the medicine must be delivered within three hours from the onset of symptoms. Only 3 percent to 5 percent of stroke victims reach a hospital in time to receive this treatment, according to the American Stroke Association.
"It varies from patient to patient," Jordan said. "I don't know which patient is going to have brain to save until I have done really detailed images."
Although Heacock's stroke was small in scope, her mother doesn't want other parents to make the same mistake she did.
"I should have taken her to the emergency room that night," Darr said.