In children under age 10 years, the most common cause of stroke is cerebral infarction. Ischemic stroke typically presents with signs and symptoms of hemiparesis or monoparesis, hemianesthesia, visual field deficits, aphasia, cranial nerve palsies, or acute change in behavior. Although recovery occasionally is complete, intellectual, motor, and sensory impairments are typical sequelae. Intracranial hemorrhage becomes increasingly more common with advancing age. In hemorrhagic stroke, more generalized phenomena such as coma, headache, and seizures occur.
Recurrent stroke causes progressively greater impairment and increased likelihood of mortality.
Nonfocal complaints such as dizziness, headache, or fainting are not in themselves representative of cerebral vascular disease but should be investigated carefully. TIA often is a harbinger of subsequent stroke. Infarction usually occurs in a segmental pattern that suggests damage to the large cerebral arteries. Multiple, bilateral vessel involvement is usual, even in patients who have unilateral neurologic signs. Vessel narrowing is the consequence of intimal and medial proliferation that is thought to be caused by endothelial damage from sickled red blood cells.