Pediatric Stroke
What You Need to Know
- A stroke is a brain injury caused by the interruption of blood flow to part of the brain.
- Without prompt and appropriate treatment, stroke can be life threatening for children, and requires immediate medical attention.
- Prompt diagnosis and treatment can minimize the risk of lasting problems, and early rehabilitation can help maximize recovery.
What is pediatric stroke?
Pediatric stroke is the same as a stroke that occurs in adults. A stroke is a brain injury caused by the interruption of blood flow to part of the brain. Stroke can be caused by a blocked blood vessel (ischemic stroke) or by bleeding in the brain (hemorrhagic stroke). The brain needs a constant supply of oxygen, which is carried by the blood. When blood flow stops, brain cells start to die.
Stroke is among the top 10 causes of death among children. Pediatric stroke can also cause neurologic disability, with a risk of permanent cognitive and motor impairment.
IF YOU SUSPECT YOUR CHILD IS HAVING A STROKE, CALL 911 OR GO TO THE NEARST EMERGENCY ROOM IMMEDIATELY.
Pediatric Stroke Signs and Symptoms
A stroke typically begins suddenly in children and infants. Symptoms depend on the child’s age and the cause of the stroke. In newborns, you might see:
- Seizures
- Extreme sleepiness or altered mental status
- Tendency to use only one side of the body
In young children, the diagnosis is often delayed. In older children, stroke symptoms are more like the symptoms seen in adults and may include:
- Severe headache, possibly with vomiting
- Trouble with vision or moving the eyes
- Weakness or numbness on one side of the body or face
- Dizziness or sudden confusion
- Trouble walking or loss of balance or coordination
- Trouble seeing
- Trouble speaking or understanding speech
- Sleepiness or loss of consciousness
- Seizure or paralysis of one part of the body
If your child has symptoms of stroke, call 911 or your local emergency number.
FAST is an easy way to remember the signs of a stroke. When these signs are detected, call 911 or go to the nearest emergency room.
- F is for face drooping. One side of the face is drooping or numb. When the person smiles, the smile is uneven.
- A is for arm weakness. One arm is weak or numb. When the person lifts both arms at the same time, one arm may drift downward.
- S is for speech difficulty. You may notice slurred speech or difficulty speaking. The person can’t repeat a simple sentence correctly.
- T is for time to call 911. If someone shows any of these symptoms, even if they go away, call 911 or go to the nearest emergency room immediately. Note the time the symptoms first appeared.
Pediatric Stroke Causes and Risk Factors
Causes of pediatric stroke include:
- Congenital heart defects
- Problems with blood vessels supplying the brain
- Blood clotting disorders
- Sickle cell disease
Risk factors for pediatric stoke include:
- Arrhythmias
- Congenital heart defects
- Diabetes
- High blood pressure
- Obesity
- Thrombophilia or hemophilia
- Lack of oxygen to the brain at birth
- Serious brain or neck injury
- Genetic syndromes, such as Down syndrome
Pediatric Stroke Diagnosis
Diagnosis of pediatric stroke begins with a review of the child or infant's symptoms and health history by a pediatrician or neurologist. This review is essential to start treatment quickly and lower the risk of long-term problems. The care team will ask about injuries, infection, problems with growth and development, and family history of bleeding problems. The team will also look for signs of weakness, numbness or other signs of stroke. Several tests may be performed, including:
- Brain imaging studies
- Brain magnetic resonance imaging (MRI) is the preferred test for stroke diagnosis for children.
- Computed tomography (CT) scans are good options if MRI is not available.
- Magnetic resonance angiography (MRA) may also be performed as part of the MRI.
- Electroencephalogram (EEG) may be conducted to look for evidence of seizures.
- Transcranial Doppler (ultrasound of the brain) may be performed to look for abnormalities of brain blood vessels.
- Blood tests for signs of infection, sickle cell disease, inflammation of blood vessels and blood clotting abnormalities.
- Pulse oximetry may be performed to be sure there is enough oxygen in the blood.
- Heart and blood vessel studies
.- An electrocardiogram (ECG) is used to look in the heart for possible causes of air embolism or blood clot. A monitor may also be worn to look for heart rhythm abnormalities over a prolonged time.
- During a catheter angiogram scan, a thin, flexible tube is inserted into blood vessels, contrast is injected, and X-rays are used to take pictures of the arteries and veins in the brain.
- During a lumbar puncture, fluid surrounding the brain and spinal cord (cerebrospinal fluid) is checked for blood or signs of infection.
To help identify the cause of a stroke, children and infants may need to see other specialists such as intensive care doctors, hematologists (specialists in blood disorders), neurologists, neurosurgeons, interventional radiologists and rehabilitation doctors who specialize in function recovery after stroke.
Pediatric Stroke Treatment
Treatment works best if it is started as soon as possible after a stroke occurs. Treatments and long-term outcome for children and infants are different for each type of stroke. In the early stages of a stroke, the treatment centers around supporting blood flow to the brain.
Treatment may be a combination of the following.
- Intravenous (IV) fluids. These are important to supply fluids to avoid or reverse dehydration.
- Medical therapy. The child may receive aspirin or other blood thinners (anticoagulants) and special vitamins. Children with sickle cell disease and stroke may be treated with hydroxyurea, transfusion therapy or both. If the stroke is causing seizures, the child may need antiseizure medication as well.
- “Clot-busting” medications used successfully for adults have not yet been approved for use by children, but they may be considered in certain situations.
- Interventional neuroradiology. If the child has abnormal connections in blood vessels that feed the brain (arteriovenous malformations) or a blood vessel with weakened walls that can bulge and tear (aneurysm), the doctor may place a catheter inside the affected blood vessel to help repair the abnormal area. In some situations, a catheter can be used to remove large clots in blood vessels and help restore essential blood flow to the brain. These interventional neuroradiology procedures are performed with a catheter inserted into a blood vessel in the arm or leg and guided into blood vessels in the brain.
- Surgery. A surgical procedure may be appropriate for certain types of stroke and other cerebrovascular disorders. The type of surgery for a stroke depends on the cause of the stroke. Surgery to remove a piece of bone (craniectomy) may be required in cases with severe brain swelling. Other surgeries for stroke include closure of abnormal blood vessels, removal of abnormal areas of the brain and rerouting blood vessels to help provide blood supply to injured areas.
Pediatric Stroke Recovery
Overall, a child’s growing brain has a better chance of recovering from stroke than an adult’s brain. Prompt diagnosis and treatment can minimize the risk of lasting problems, and early rehabilitation can help maximize recovery.
Follow-up care is extremely important for stroke recovery. Once the child is stabilized, the medical team will work with the patient and family to create an ongoing plan to assess the child’s function and optimize recovery. After the initial treatment, the child will receive physical, occupational and rehabilitation therapy.
Depending on where in the brain the stroke occurred, the child may have difficulty walking, seeing, speaking or reading, sometimes with one side of the body affected more than the other. The stroke may cause a seizure disorder or have an impact on the child’s thinking or emotions.
Pediatric Stroke Prevention
For children and infants, the first instance of a stroke is usually the first warning, so there may be no way to prevent the first stroke. To help prevent a second stroke, the care team will treat the condition that may have led to the first stroke. Medicines, and surgery and other procedures, may be part of the treatment.
