ED Stroke Management Process

At-a-glance Signs & Symptoms of Childhood Stroke Syndromes*

Acute Arterial Ischemic Stroke or TIA

Medical description Lay description Comment
Hemiparesis Weak arm or leg, facial droop, paralyzed on one side Combination of face with arm, or face, arm & leg strongly suspicious for stroke
Aphasia Stopped speaking, talking nonsense, won’t follow command Sometimes mistaken for confusion or oppositional behavior
Visual field cut Loss of vision, can’t see right Often causes gaze preference toward the side of intact vision, away from the hemiparetic side
Ataxia Unsteady gait, can’t walk straight, seems drunk, can’t sit steady, uncoordinated reach/grasp Often associated with headache, complaint of dizziness, vomiting
Dysarthria (slurred speech) Speech is slurred, though word choice & comprehension are correct  
Hemisensory loss Numbness, tingling on one side of body Usually involves one side of body & more than one body region (face+arm, or face+arm+leg)
New-onset focal seizures with atypical prolonged (>1 hr) post-ictal deficit   No previous dx of epilepsy, now has several focal seizures followed by persisting weakness in location of the seizure (usually face+arm or face+arm+leg)

Acute Cerebral Sinovenous Thrombosis

Medical description Lay description Comment
Triad of unremitting & escalating headache, repeated vomiting and decreased mental status Lethargic, vomiting, irritable, headache Frequently has 6th nerve palsy & papilledema

Primary Intracranial Hemorrhage (IVH, Subarachnoid Hemorrhage, AVM)

Medical description Lay description Comment
Hyperacute severe headache “Worst headache of my life” Often quickly followed by decreased mental status
Sudden sustained loss of consciousness "collapsed", can't awaken Often preceded by c/o headache, vomiting &/or seizure
One or both of above with new focal deficit Paralyzed on one side, eyes going to one side, face drooping  

*Developed by CHOP Stroke Team, for screening & triage by nursing staff and emergency medicine providers.

Rev 01.18.06