Overview

What is a pediatric stroke?

A pediatric stroke is a stroke that occurs before the age of 18. It includes:

  • Perinatal strokes, which your child can be born with.
  • Strokes before 28 days of life.
  • Childhood strokes that occur after 28 days of life, before the age of 18 years.

Stroke occurs when blood doesn’t flow to your brain as it should. It’s life-threatening and even though it’s more likely in adults, children and adolescents can sometimes have one. Common causes include heart disorders and blood clotting disorders. Strokes can also occur due to injuries that result from low oxygen to your child’s brain or conditions they’re born with (congenital conditions). Get prompt medical care as soon as you notice symptoms. Rehabilitation can also help your child recover.

What are the types of pediatric stroke?

Neonates (newborns less than 4 weeks old), infants, children and adolescents experience the same types of strokes that adults do:

  • Hemorrhagic stroke
  • Ischemic stroke
  • Transient ischemic attack (TIA).

How common is pediatric stroke?

Pediatric strokes are rare. Researchers estimate that there are 1 to 2 childhood stroke cases per 100,000 children (under age 18) each year. There is about 1 perinatal stroke per 3,500 live births. These numbers can be hard to estimate as strokes are challenging to diagnose.

Symptoms and Causes

🚨 What are pediatric stroke symptoms?

A child who has a stroke may experience some of the same symptoms as adults:

  • Changes in behavior or thinking.
  • Changes in hearing or vision.
  • Clumsiness (ataxia).
  • Difficulty swallowing (dysphagia).
  • Muscle weakness on one side of the body (hemiparesis).
  • Trouble speaking or understanding words (aphasia).

Note: Many children, especially infants and young children, may not have typical stroke symptoms. Instead, they may have: Seizure, Headaches, Nausea and vomiting, Fatigue, Fever.

🧬 What would cause a pediatric stroke?

In general, a stroke happens when your child’s brain doesn’t get enough blood, either due to blood clots or brain bleeds. The two types are:

  • Ischemic stroke or TIA: happens because blood clots form.
  • Hemorrhagic stroke: happens due to bleeding in the brain.

Common causes include:

  • Blood vessel malformations (e.g., arteriovenous malformation - AVM).
  • Congenital heart disease.
  • Blood disorders (e.g., sickle cell disease).

What are the risk factors for pediatric stroke?

Your child may be at a higher risk for a stroke if they have:

  • Arrhythmias.
  • Congenital heart disease.
  • Cerebral hypoxia (lack of oxygen to their brain) during birth.
  • Diabetes.
  • High blood pressure (hypertension).
  • Obesity.
  • Thrombophilia or hemophilia.
  • Traumatic brain injury (TBI) or neck injury.
  • Certain genetic syndromes. For example, Down syndrome.

What are the complications of pediatric stroke?

Many children who have a stroke tend to recover fully. But depending on which parts of their brains stroke affects, some children may have permanent changes to their thinking (cognitive) and speaking abilities. They may also be weaker on the affected side or have permanent vision changes. Children who have a stroke are also at a greater risk for developing epilepsy.

Diagnosis and Tests

How is pediatric stroke diagnosed?

It can be challenging to diagnose pediatric stroke. Symptoms aren’t always recognizable, so some children don’t get treatment right away. Providers may later figure out your child had a stroke if your child experiences a developmental delay. To make a diagnosis, a healthcare provider talks with you about your child’s symptoms. They do a physical examination and may order certain tests for your child.

🔬 What tests do providers use to diagnose pediatric stroke?

Imaging Tests (Most Sensitive for Diagnosis):

  • Brain MRI: The most sensitive test to diagnose a stroke.
  • CT scan: To check for a brain bleed or an area affected by a blood clot.
  • CT Angiogram & MRA: To check how blood flows through their heart, vessels, and brain.

Other Tests (To Determine Cause and Complications):

  • Echocardiogram (Echo): To check your child’s heart structure.
  • Electroencephalogram (EEG): To determine if they’re experiencing seizures.
  • Blood tests: To check for sickle cell disease or blood clotting conditions.
  • Genetic testing: If certain genetic disorders are the suspected cause.

Management and Treatment

Immediate Treatment is Crucial!

Pediatric stroke is a life-threatening emergency that needs immediate treatment. Call 911 (or your local emergency number) or visit the nearest emergency room if your child experiences stroke-like symptoms. Treatment depends on the type of stroke (and is time sensitive):

  • Ischemic strokes: Medications like thrombolytics (or possibly a procedure called thrombectomy) to restore blood flow.
  • Hemorrhagic strokes: Surgery may be necessary to control the bleeding.

Each hospital has a dedicated stroke protocol (series of actions) for pediatric stroke to ensure timely diagnosis and treatment.

💊 Other Medications Used:

  • Anticoagulant medications to thin their blood.
  • Antiseizure medications if your child has seizures.

Outcome / Prognosis

💪 Recovery and Rehabilitation Team

Each child’s recovery is different, but pediatric stroke rehabilitation is often necessary. They may receive care from a team of specialists, including:

  • Pediatric neurologist
  • Pediatric cardiologist
  • Pediatric hematologist
  • Pediatric neurosurgeon
  • Physical therapist
  • Speech-language pathologist (SLP)
  • Occupational therapist

Survival Rate

Many children who have ischemic stroke survive. However, delayed diagnosis can affect health outcomes, and they may be at risk for another stroke, especially if they have heart problems or blood clotting disorders.

Prevention and Ongoing Care

🛡️ Is pediatric stroke preventable?

Pediatric stroke occurs for many different reasons, including congenital conditions. There’s no way to prevent certain conditions that may be present at birth.

  • If your child has AVM, congenital heart disease, or sickle cell disease, treatment for those conditions helps prevent future strokes.
  • Your child may need periodic surveillance tests to see if they’re at high risk for strokes.

Pregnancy Risk Factors:

Conditions during pregnancy that increase risk for perinatal strokes include Gestational diabetes, Preeclampsia, and Premature rupture of membranes.

🏡 How do I take care of my child after a stroke?

Follow your provider’s instructions and ensure your child takes all medications as prescribed. Your child should also:

  • Be physically active (exercise).
  • Eat nutritious foods to help manage high cholesterol and diabetes risk.
  • Get enough sleep.

Appointment Reminder: Take your child to all scheduled appointments with their providers. Call your provider if you notice new symptoms.