What is Stroke in Children

A stroke is a sudden decrease in blood supply to part of the brain. Brain cells need oxygen and sugar in the blood to survive. Without a strong blood supply, brain cells start to die quickly. A stroke is a medical emergency that must be treated at the hospital.

A stroke can affect children at any age. There are two types of stroke that can occur in children:

• Ischemic stroke. This is caused by a blockage in a blood vessel that reduces blood supply to the brain.
• Hemorrhagic stroke. This is caused by bleeding inside the brain that reduces blood supply to the brain.

Some children may have long-term problems after a stroke, such as:

• Weakness.
• Jerky movements they cannot control (seizures or spasticity).
• Behavior problems.
• Problems with speech, language, and learning.

What are the causes?

The most common causes of ischemic stroke include:

• A blood clot that forms in the heart and travels to the brain.
• A disease or abnormality of a blood vessel in the neck or brain that carries blood to the brain.
• A brain infection or injury.
• A disease that causes the blood to clot.

The most common causes of hemorrhagic stroke include:

• A weak or abnormal blood vessel in the brain that leaks or ruptures.
• A disease that decreases the blood’s ability to form clots.
• A brain injury or tumor.

What increases the risk?

Your child may have a higher risk for stroke if he or she:

• Was born with a heart abnormality.
• Was born with a blood vessel disease or abnormality, such as moyamoya.
• Has sickle cell disease.
• Has hemophilia.
• Has had heart surgery.
• Has an abnormal heart beat (arrhythmia).
• Has a disorder that increases blood clotting.

What are the signs or symptoms?

Symptoms of stroke start suddenly. They may start and get worse, or start and go away. Stroke symptoms are always serious and require emergency treatment. They include:

• Weakness or numbness on one side of the body, especially the face, arm, or leg.
• Severe headache, especially with vomiting or sleepiness.
• Loss of the ability to speak or understand speech.
• Vision loss on one side or double vision.
• Dizziness, confusion, or clumsiness.
• Seizure.
• Behavior change, such as confusion (altered mental status).

How is this diagnosed?

This condition is diagnosed based on:

• Your child’s medical history and symptoms.
• A physical exam.
• Blood tests to check for clotting abnormalities.
• Imaging tests, such as:
  • CT scan. This is usually the first test.
  • CT angiogram. During this test, dye is injected into the blood and then X-rays are taken. Dye helps blood flow show up on the X-rays.
  • MRI.
  • MRI angiogram. This is a type of MRI used to evaluate the blood vessels.
  • Doppler ultrasound. This test uses sound waves to show the arteries.
  • Echocardiogram. This test uses sound waves (ultrasound) to produce an image of the heart.

How is this treated?

A stroke always requires emergency treatment at the hospital. Treatment depends on the cause. Emergency treatment may include:

• Receiving fluids and sugar through an IV.
• Medicine that helps:
  • Control blood pressure.
  • Thin the blood and prevent clotting (anticoagulants), for ischemic stroke.
  • Reduce swelling in blood vessels or brain tissue.
  • Control and prevent seizures.
• Receiving donated blood through an IV (blood transfusion). This may be done if your child has sickle cell disease.
• Antibiotic medicine, if your child has a brain infection.
• Surgery to repair a leaking blood vessel, remove a clot, or take pressure off the brain.

After emergency treatment, other treatments may include:

• Medicines to prevent blood clots, for ischemic stroke.
• Monitoring blood vessels with ultrasounds (transcranial Doppler, TCD). This may be done if your child has sickle cell disease.
• Physical therapy.
• Speech and language therapy.

Follow these instructions at home:

• Work closely with all your child’s health care providers. Have your child do exercises and speech therapy as directed.
• Give your child over-the-counter and prescription medicines only as told by your child’s health care provider.
• Have your child return to normal activities as told by his or her health care provider. Ask your child’s health care provider what activities are safe for your child.
• If your child is taking blood thinners:
  • Talk with your child’s health care provider before you give your child any medicines that contain aspirin or NSAIDs. These medicines increase the risk of dangerous bleeding.
  • Have your child take his or her medicine exactly as told, at the same time every day.
  • Have your child avoid activities that could cause injury or bruising, and follow instructions about how to prevent falls.
  • Have your child wear a medical alert bracelet or carry a card that lists what medicines he or she takes.
• Make sure your child drinks enough fluid to keep his or her urine pale yellow.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if your child:

• Has a fever.
• Is taking blood thinners and has unusual bruising or bleeding.
• Has behavioral problems or problems at school.

Get help right away if:

• Your child’s symptoms suddenly get worse.
• Your child has any symptoms of a stroke. “BE FAST” is an easy way to remember the main warning signs of a stroke:
  • B – Balance. Signs are dizziness, sudden trouble walking, or loss of balance.
  • E – Eyes. Signs are trouble seeing or a sudden change in vision.
  • F – Face. Signs are sudden weakness or numbness of the face, or the face or eyelid drooping on one side.
  • A – Arms. Signs are weakness or numbness in an arm. This happens suddenly and usually on one side of the body.
  • S – Speech. Signs are sudden trouble speaking, slurred speech, or trouble understanding what people say.
  • T – Time. Time to call emergency services. Write down what time symptoms started.
• Your child has other signs of a stroke, such as:
  • A sudden, severe headache with no known cause.
  • Nausea or vomiting.
  • Seizure.
  • Behavior changes, such as sudden confusion.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.).

Summary

• A stroke is a sudden decrease in blood supply to part of the brain.
• Symptoms of stroke start suddenly. Stroke symptoms are always serious and require emergency treatment.
• If your child is taking blood thinners, have your child wear a medical alert bracelet or carry a card that lists what medicines he or she takes.
• “BE FAST” is an easy way to remember the main warning signs of a stroke.