Strobe lights flashed and snow, like on a television set, appeared before Anna Branscome.
Then came terrible migraines and fainting spells.
The Bloom-Carroll High School student visited her local emergency room more than once, only to be told by doctors that there was nothing they could find, that it was likely in her head, she said.
"Well, it was in my head, but not the way they meant," said Branscome, who was admitted on Wednesday to Nationwide Children's Hospital.
The 17-year-old has had many strokes, including two in the past 10 days. Her symptoms started in December. After about a month, her doctor ordered an MRI that revealed multiple clots in her brain.
"It was a combination of relief and fear because the worst part was not knowing what was wrong with me," Branscome said.
It's been a frustrating seven months, full of emotion and obstacles. But news yesterday that the condition that has changed her life is gaining greater recognition was a bright spot.
The American Heart Association issued first-ever guidelines yesterday for diagnosing and treating stroke in young people. The scientific statement was published in this week's Stroke: Journal of the American Heart Association.
The doctors behind the effort say they hope it will serve as an alert to both the medical community and parents.
"If you interrupt the blood supply, it's just as detrimental in a 10-year-old as an 80-year-old," said Dr. E. Steve Roach, chief of neurology at Children's Hospital and chairman of the group that wrote the guidelines.
The guidelines will help doctors evaluate children and find appropriate treatment and therapy, which varies depending on the child, the cause and other factors.
"Most physicians don't get a lot of experience or training in the treatment of childhood stroke," said Dr. James Bale, a pediatric neurologist and associate chairman of the department of pediatrics at Primary Children's Medical Center in Utah.
Bale reviewed the guidelines before they were published and said they're an extremely important step in improving care.
Of 100,000 people 18 or younger, about 11 will have a stroke each year. Risk is highest for newborns; stroke in the first month of life occurs in about one of every 4,000 births, according to the heart association.
Incidence is highest among two groups: those with sickle-cell disease and those with congenital heart defects that increase the risk of clots, Roach said.
In Branscome's case, the clots that prompt the strokes are coming from a tear in an artery in her neck, a condition that can result from a relatively minor injury to the head or neck. Doctors hope it will heal on its own, she said, but if it doesn't, they might operate. In the meantime, she's on blood thinners.
Detecting stroke can be tricky, particularly in infants, Roach said.
"It's not like one giant light bulb goes off and all these kids get recognized," he said.
"Kids don't simply slur their cry."
Recognition has improved in the past two decades thanks to better-informed physicians and improved imaging techniques, Roach said, but there's still a long way to go.
Stroke care can vary greatly from one community to the next, and only a handful of centers specialize in pediatric stroke. One is here, at Children's.
Sometimes, symptoms might not show up until infants reach developmental milestones, such as walking and talking, said Dr. Jose Biller, chairman of the Department of Neurology at Loyola University in Chicago and one of the authors of the guidelines.
In older children, symptoms might be more evident, including weakness in half the body, seizures and speech problems, he said.
Once a stroke happens, applicable treatment and therapy should be started as soon as possible, doctors say.
In a select group of high-risk sickle-cell patients, for instance, blood transfusions can stop subsequent strokes.
mcrane@dispatch.com
"If you interrupt the blood supply, it's just as detrimental in a 10-year-old as an 80-year-old."
Dr. E. Steve Roach
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