What is Pediatric Stroke?
Stroke happens when blood that carries oxygen and nutrients stops flowing to part of the brain. Without a steady supply of blood, brain cells in the area begin to die within seconds. This can lead to stroke symptoms and sometimes to lasting neurologic deficits or sadly, death.
While most have heard of stroke in adults, a stroke can and does happen at any age. Stroke can happen in newborns, children, teens – and even before birth. Perinatal strokes and childhood strokes are often different from adult strokes, with different causes and sometimes different symptoms and treatments.
A stroke is a medical emergency. If you think a child is having a stroke, call 911. A rapid response, quick diagnosis and treatment may help limit damage to the brain.
While most have heard of stroke in adults, a stroke can and does happen at any age. Stroke can happen in newborns, children, teens – and even before birth. Perinatal strokes and childhood strokes are often different from adult strokes, with different causes and sometimes different symptoms and treatments.
A stroke is a medical emergency. If you think a child is having a stroke, call 911. A rapid response, quick diagnosis and treatment may help limit damage to the brain.
Quick Glance at the facts:
There are two age categories for pediatric stroke:
•Recognition of stroke is often delayed or even missed in children.
•Stroke is as common as brain tumors in the pediatric population.
•Stroke is one of the top ten causes of death for children.
•Of children surviving stroke, about 60% will have permanent neurological deficits, most commonly hemiparesis or hemiplegia. Hemiplegia/hemiparesis (total or partial paralysis on one side of the body) is the most common form of cerebral palsy in children born at term, and stroke is its leading cause.
•Other long-term disabilities caused by a stroke in childhood include cognitive and sensory impairments, epilepsy, speech or communication disorder, visual disturbances, poor attention, behavioral problems, and poor quality of life.
- Perinatal, which refers to the last 18 weeks of gestation through the first 30 days after birth. Other terms for this include fetal, prenatal, in utero for the period before birth. Neonatal and newborn for birth through one month of age.
- Childhood, ages 1 month to 18 years
- Estimates reflect that stroke occurs in infants younger than 1 month of age roughly 1 out of every 2000 live births. With the risk of stroke from age 1 month to 19 years, being 5 per 100,000 children.
•Recognition of stroke is often delayed or even missed in children.
•Stroke is as common as brain tumors in the pediatric population.
•Stroke is one of the top ten causes of death for children.
•Of children surviving stroke, about 60% will have permanent neurological deficits, most commonly hemiparesis or hemiplegia. Hemiplegia/hemiparesis (total or partial paralysis on one side of the body) is the most common form of cerebral palsy in children born at term, and stroke is its leading cause.
•Other long-term disabilities caused by a stroke in childhood include cognitive and sensory impairments, epilepsy, speech or communication disorder, visual disturbances, poor attention, behavioral problems, and poor quality of life.
•The majority of pediatric strokes occur in the perinatal period.
•To many people’s surprise, the most focused period of risk for ischemic stroke in your lifetime is the week you are born.
•In most perinatal strokes, a cause cannot be found.
•For perinatal strokes, the overall risk for another stroke is extremely low, < 1%.
•Showing a hand preference, or consistently reaching out with only one hand before 1 year of age may be an indication of an earlier perinatal stroke.
•When stroke affects a newborn infant, symptoms may not appear until 4 to 8 months of age in the form of decreased movement or weakness of one side of the body.
•Cerebral Palsy (CP) refers to a motor (physical movement) difficulty which results from an abnormality or injury to the brain before or around the time of birth. Therefore, for stroke, the term CP only applies to perinatal stroke.
•To many people’s surprise, the most focused period of risk for ischemic stroke in your lifetime is the week you are born.
•In most perinatal strokes, a cause cannot be found.
•For perinatal strokes, the overall risk for another stroke is extremely low, < 1%.
•Showing a hand preference, or consistently reaching out with only one hand before 1 year of age may be an indication of an earlier perinatal stroke.
•When stroke affects a newborn infant, symptoms may not appear until 4 to 8 months of age in the form of decreased movement or weakness of one side of the body.
•Cerebral Palsy (CP) refers to a motor (physical movement) difficulty which results from an abnormality or injury to the brain before or around the time of birth. Therefore, for stroke, the term CP only applies to perinatal stroke.
Perinatal Stroke Facts, Signs & Symptoms
Perinatal stroke symptoms
Seizures are a common symptom of perinatal stroke. They usually start 12 to 48 hours after birth and repeat.
Some babies have no clear symptoms for weeks or months after their stroke. Often parents, caregivers and doctors do not notice any signs of perinatal stroke until age 4 to 6 months, when the baby starts to seem weaker or partly paralyzed on one side of the body (hemiplegia or hemiparesis).
Symptoms may include:
Perinatal Stroke Risk Factors:
Seizures are a common symptom of perinatal stroke. They usually start 12 to 48 hours after birth and repeat.
Some babies have no clear symptoms for weeks or months after their stroke. Often parents, caregivers and doctors do not notice any signs of perinatal stroke until age 4 to 6 months, when the baby starts to seem weaker or partly paralyzed on one side of the body (hemiplegia or hemiparesis).
Symptoms may include:
- Baby not moving 1 side of their body as well as the other
- Baby keeping fingers and toes on one side of the body clenched in a fist
- Child clearly using 1 hand more than the other (not common before age 1 in healthy babies)
Perinatal Stroke Risk Factors:
- Disorders of the Placenta
- Congenital heart disease
- Sickle cell disease or other blood conditions that cause abnormal clotting (thrombosis) or bleeding
- Infections such as meningitis
Childhood Stroke Facts, Signs & Symptoms
•For children who have an initial stroke, the risk for recurrent strokes is between 15% and 18%.
•Early recognition and treatment during the first hours and days after a stroke is critical in optimizing long-term functional outcomes and minimizing recurrence risk.
•Many children with stroke symptoms are misdiagnosed with more common conditions that mimic stroke, such as migraines, epilepsy or viral illnesses.
Childhood stroke symptoms
Childhood strokes may be missed because there is a lack of awareness that children can indeed have a stroke. At first, stroke may even be diagnosed as something else.
Children who have a stroke after the perinatal period tend to have 1 or more of these symptoms that come on suddenly:
Childhood Stroke Risk Factors
Childhood strokes may be missed because there is a lack of awareness that children can indeed have a stroke. At first, stroke may even be diagnosed as something else.
Children who have a stroke after the perinatal period tend to have 1 or more of these symptoms that come on suddenly:
- Weakness, paralysis or numbness in the face, arm or leg, usually on one side of the body
- Trouble speaking, understanding language, reading or writing (aphasia)
- Changes in vision, such as decreased vision or double vision
- Dizziness, loss of balance or loss of ability to stand or walk
- Sudden, severe headache
- Seizures in a child who has not had seizures before – especially seizures that involve only one side of the body, followed by weakness on that side
Childhood Stroke Risk Factors
- Congenital heart disease
- Abnormal blood vessels in the brain, such as Moyamoya, arteriovenous malformation, vasculitis
- Infections
- Head Injury or Trauma
- Sickle cell disease or other blood conditions that cause abnormal clotting (thrombosis) or bleeding
- Autoimmune Disorders
Types of Stroke:
Ischemic stroke
In ischemic stroke, the blood vessel may be blocked by a blood clot that formed in the blood vessel (thrombus) or a clot that formed somewhere else in the body, such as the heart, and then traveled to the brain through the bloodstream (embolism).
Doctors group pediatric ischemic strokes by the age of the child.
Hemorrhagic stroke
In hemorrhagic stroke, the lack of oxygen-rich, nutrient-rich blood to brain cells is only one problem. Another problem is that blood builds up where it does not belong — in the brain but outside a blood vessel. This blood can put pressure on the brain, form clots or cause nearby blood vessels to close up (vasospasm), which can also damage the brain.
Causes of hemorrhagic stroke include:
In ischemic stroke, the blood vessel may be blocked by a blood clot that formed in the blood vessel (thrombus) or a clot that formed somewhere else in the body, such as the heart, and then traveled to the brain through the bloodstream (embolism).
Doctors group pediatric ischemic strokes by the age of the child.
- Perinatal ischemic stroke (PIS): Stroke before birth or in a newborn (age 28 days or younger)
- Childhood arterial ischemic stroke (childhood AIS or CAIS): Stroke at age 29 days or older
Hemorrhagic stroke
In hemorrhagic stroke, the lack of oxygen-rich, nutrient-rich blood to brain cells is only one problem. Another problem is that blood builds up where it does not belong — in the brain but outside a blood vessel. This blood can put pressure on the brain, form clots or cause nearby blood vessels to close up (vasospasm), which can also damage the brain.
Causes of hemorrhagic stroke include:
- Weak blood vessel bursting
- Trauma, such as a head injury, that tears the wall of a blood vessel
- Blood that does not clot as well as it should
Stroke Diagnosis:
The diagnosis of stroke in children requires recognition of presenting signs and symptoms leading to a careful clinical history and examination combined with appropriate brain imaging studies.
To see pictures of your child’s brain and look for blockage, bleeding or problems with the blood vessels, the doctor may ask for your child to have one or more of these imaging studies:
Your child may also have one or more of these tests performed:
To see pictures of your child’s brain and look for blockage, bleeding or problems with the blood vessels, the doctor may ask for your child to have one or more of these imaging studies:
- CT (computed tomography) scan
- MRI (magnetic resonance imaging) scan
- MRA (magnetic resonance angiography)
- Ultrasound
- Cerebral angiogram
Your child may also have one or more of these tests performed:
- Blood tests to check for clotting or bleeding problems, infection or diseases that might increase stroke risk
- Echocardiogram to check for heart problems
- Electrocardiogram to check for problems with heart rate or rhythm
- Electroencephalogram to look for the cause of seizures
Treatments:
Treatment for perinatal stroke and childhood stroke depends on:
If a blood clot is blocking blood flow in your child’s brain (ischemic stroke), doctors may use blood thinners (antithrombotics, either antiplatelets or anticoagulants) to keep clots from getting larger and to prevent new clots. In general, (tPA), a medicine that dissolves clots, is used in children only as part of a clinical trial. This drug is widely used in adults in the hours right after an ischemic stroke. However, Doctors are still studying how it affects children and which children can benefit.
If an artery in your child’s brain is bleeding (hemorrhagic stroke), a neurosurgeon may have to surgically repair the artery.
If your child has an underlying condition that might have caused the stroke — and might put your child at risk for future strokes or other health problems — doctors will recommend treatment for this condition
Whatever the cause or effects of your child’s stroke, a diagnosis of stroke can be overwhelming. You are not alone. Support is an important part of care for your entire family
- The type of stroke
- The short-term and long-term effects of the stroke
- Any underlying condition that caused the blockage or bleeding in your child’s brain
If a blood clot is blocking blood flow in your child’s brain (ischemic stroke), doctors may use blood thinners (antithrombotics, either antiplatelets or anticoagulants) to keep clots from getting larger and to prevent new clots. In general, (tPA), a medicine that dissolves clots, is used in children only as part of a clinical trial. This drug is widely used in adults in the hours right after an ischemic stroke. However, Doctors are still studying how it affects children and which children can benefit.
If an artery in your child’s brain is bleeding (hemorrhagic stroke), a neurosurgeon may have to surgically repair the artery.
If your child has an underlying condition that might have caused the stroke — and might put your child at risk for future strokes or other health problems — doctors will recommend treatment for this condition
Whatever the cause or effects of your child’s stroke, a diagnosis of stroke can be overwhelming. You are not alone. Support is an important part of care for your entire family
Sources: Seattle Children's Hospital, Pediatric Stroke Program, "About Pediatric Stroke"
American Heart Association, "FACTS Knowing No Bounds: Stroke in Infants, Children, and Youth", 2013 update
Stroke awareness at any age- Educational Video
Pediatric Stroke Warriors and SparkVids Media presents the following educational video in heightening the awareness of the signs and symptoms of stroke in a child at any age. This 3 minute educational video highlights stroke recognition in both newborns and children of all ages.
AWARENESS LEADS TO A QUICKER RESPONSE AND LIFESAVING OUTCOMES FOR CHILDREN.
AWARENESS LEADS TO A QUICKER RESPONSE AND LIFESAVING OUTCOMES FOR CHILDREN.
Talking About The Facts: Stroke In Children
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While most have heard of stroke in adults, a stroke can and does happen at any age. We believe in the value of education and how increased knowledge can lead to a quicker response and better the lives of children and families impacted by strokes. This five page resource is specific to the general education of stroke in children and highlights the risk factors, signs and symptoms of both perinatal and childhood stroke. |