Before seven-year-old Connor Halloran had a stroke last May, his parents – like many people – had no idea such a thing could happen to a child, let alone one so young.
Around 50 per cent of strokes in under-18s are haemorrhagic – where a blood vessel around the brain bursts and bleeds.
And in one of five of such cases, such as Connor’s, this is due to a malformation in the blood vessels of the brain called an arteriovenous malformation (AVM) that can be present from birth.
Yet terrifyingly, until these fragile blood vessels leak or burst, it’s often impossible to know an AVM is there.
Although sometimes there may be symptoms – and if reported promptly, a brain scan can detect an AVM – often there are no warning signs, say experts.
Certainly Connor’s parents, Sally, 29, a science teacher, and Ryan, 28, a school site manager, had no idea their son was anything other than a normal, healthy and boisterous child.
‘He loved playing football with his friends, riding his scooter at top speed and going to the skatepark,’ recalls Ryan. ‘What then happened was so very sudden, there was no warning at all.’
The family’s ordeal began on a Sunday in May last year, when the then five-year-old Connor’s mother noticed he seemed a bit tired and emotional – but put it down to the fact the family had just moved to a new home in Weymouth and Connor had started a new school.
Doctors explained that Connor Halloran needed an emergency craniotomy – temporarily removing the top of his skull to relieve pressure and stop the brain bleed – to save his life
Ryan was making brunch in the kitchen and Sally had just settled Connor’s six-month-old sister, Maura, for a nap, when Connor came into the room: it was quickly clear something was badly wrong.
‘He was wailing, incredibly distressed, not able to get any words out, and banging his head with his hand,’ says Ryan.
Sally, who initially assumed her son had fallen and banged his head, adds: ‘It wasn’t like normal crying. He looked delirious, didn’t seem to know where he was and was disoriented and confused.’
They immediately called 999 – but before the ambulance could reach them Connor started to have seizures, to the horror of his terrified parents.
Then they saw that his left cheek was drooping and his left side was paralysed. ‘That’s when we realised he’d had a stroke,’ says Ryan.
Sally adds: ‘We’d never heard of a child having a stroke, but all the signs were there. We were in a complete panic because we knew it was important we got treatment quickly. Running through my head was: will he walk and talk again, will he remember me?’
Paramedics arrived within ten minutes, administered anti-seizure medication and blue-lighted Connor and Sally to hospital in Dorchester.
More than 100,000 strokes happen every year in the UK – 15 per cent of these occur in those under 60, with a small fraction, around 400, in children and babies.
‘A stroke occurs when the blood supply to part of the brain is cut off, killing brain cells,’ explains Professor Deb Lowe, a consultant stroke physician for Wirral University Teaching Hospital and medical director for the Stroke Association.
‘Around 85 per cent of strokes in the UK are ischaemic strokes, caused by a blocked blood vessel. The other 15 per cent are, like Connor’s, due to bleeding in or around the brain, known as haemorrhagic stroke.’
Around half of adult strokes are linked to risk factors such as high blood pressure, and lifestyle choices such as smoking, diet and physical activity.
In contrast, childhood strokes are usually linked to underlying medical conditions – these include congenital or acquired heart disease, diseases affecting the blood vessels in the brain, blood-clotting disorders, infections, autoimmune or inflammatory conditions, head or neck trauma, says Professor Lowe.
Another cause is bleeding from abnormal blood vessels such as an AVM.
Professor Lowe explains that, in a healthy person, blood flows from arteries into tiny capillaries, which serve to slow the blood flow back into the veins.
‘But in an AVM, that “buffer zone” is missing – so blood rushes directly from arteries into veins under high pressure. Over time, these fragile vessels can burst and cause bleeding in the brain.’
AVMs are present at birth and rare – one study suggested only one child per 2,000 to 5,000 will have one. An AVM often remains silent, only causing symptoms when they rupture, which can happen during childhood or adulthood, typically between the ages of 20 and 40.
Children may also not exhibit symptoms normally associated with stroke, adds Professor Lowe.
‘Some children show classic “FAST” symptoms – ask: has their Face fallen, can they raise their Arms, is Speech slurred? – but many will not,’ she says.
Other possible warning signs of a stroke in a child include a sudden and severe headache, vomiting, drowsiness, seizures, problems with balance, changes in vision, or weakness or numbness on one side of the body.
She adds: ‘There is little parents can do to prevent it, but if something isn’t right or symptoms come on suddenly, trust your instincts and call 999.’
Seven-year-old Connor with his parents, Sally, 29, and Ryan, 28, and his sister Maura. His parents are proud of the way he has adapted to life after his stroke. He plays for a disabled football team and has his sights set on being a Paralympian
Connor is having hydrotherapy, occupational therapy and physiotherapy three times a week. He relies on a wheelchair for school, but can now walk short distances. He also has full use of his left arm, though his hand is still weak
A childhood stroke can have a lifelong impact on the child and their family. It can affect how a child moves, speaks, sees and swallows, says Professor Lowe.
‘It can also affect learning, memory, behaviour and mood. Some children have visible physical disabilities, such as reduced movement, while others experience hidden effects such as fatigue, cognitive difficulties, emotional challenges or pain.’
The terrifying severity of Connor’s condition became apparent as soon as he arrived in hospital. Doctors explained that he had a bleed on his brain and needed an emergency craniotomy – temporarily removing the top of his skull to relieve pressure and stop bleeding – to save his life.
‘I dropped to the floor crying,’ says Sally. ‘I knew our lives had changed for ever.’
The little boy’s condition was considered so grave there was not even time to wait for Ryan, who was travelling behind.
‘I was told he had a 1 per cent chance of survival and with every minute that passed, his chances diminished,’ says Sally.
Connor was sedated, stabilised and placed on a cooling mat to reduce swelling in his brain and cut the risk of further damage – before being rushed by ambulance to Southampton General Hospital, 60 miles away.
He underwent a seven-hour operation to stop the bleeding, which covered the whole of the right side of his brain – the area controlling speech and movement on the left side of his body.
The little boy spent the next 36 hours in an induced coma and his parents were warned he’d probably have significant weakness on his left side for life. The following day, a CT angiogram (where a tiny camera is fed through a vein in the groin to the brain) to determine the cause of the bleed revealed a tangle of abnormal vessels deep in the right of his brain, confirming it was an AVM.
Doctors warned that this could cause future bleeds so, just over three weeks later, Connor had surgery to remove the tangle of abnormal blood vessels, followed by intensive physiotherapy, of up to two hours a day, to re-learn how to swallow, chew and speak.
Connor spent four months in hospital before returning home – and starting part-time school again – last October.
He’s having hydrotherapy, occupational therapy and physiotherapy three times a week. He relies on a wheelchair for school, but can now walk short distances. He also has full use of his left arm, though his hand is still weak.
His parents are understandably delighted with his progress, but it’s still an uphill struggle.
Ryan is now Connor’s full-time carer, which entails ‘needing to constantly push Connor to do better and complete rehab sessions’, says Sally. This initially put a strain on the relationship between father and son, although this is now improving. His rehab and educational plan will not change until he is an adult.
His parents are proud of the way Connor has adapted.
‘He accepted what has happened to him – and refused to let it hold him back,’ says Sally.
‘He’s just adjusted his own expectations. He plays for a disabled football team and has his sights set on being a Paralympian,’ she adds.
‘We want people to know strokes can happen to children and recovery depends on how fast you call for help. If we’d hesitated that day, the outcome might have been very different.’
