Pediatric Stroke

What is pediatric stroke?

A stroke occurs when blood flow to an area of the brain is blocked or interrupted, either by a blood clot or a broken blood vessel.  When either of these things happen, brain cells begin to die and brain damage can occur.

Pediatric stroke affects 25 in 100,000 newborns and 12 in 100,000 children under 18 years of age. Stroke is the sixth leading cause of death in children. Children at risk of stroke include:

  • Newborns, especially full-term infants
  • Older children with sickle cell anemia, congenital heart defects, immune disorders or problems with blood clotting
  • Previously healthy children who are found to have hidden disorders such as narrow blood vessels or a tendency to form blood clots easily

Recognition of stroke is often delayed or even missed in most children. Many children with stroke syndromes are misdiagnosed with more common conditions that mimic stroke, such as migraines, epilepsy or viral illnesses.

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.

Types of pediatric stroke

  • Arterial ischemic stroke (AIS): Brain injury caused by blockage of blood flow in an artery caused by a blood clot or narrowing of the artery.
  • Cerebral sinovenous thrombosis (CSVT): Impaired brain function or brain injury caused by blocked drainage of blood from the brain by clotting in the brain's venous system. It may go away before permanent damage is done to the brain or it may cause an ischemic stroke or intracranial hemorrhage.
  • Intracranial hemorrhage: Bleeding in the brain that leads to brain injury. Arteries and other small blood vessels create pathways throughout the brain that bring blood from the heart. If these arteries or blood vessels weaken and burst, they can cause a hemorrhagic stroke.

Signs and symptoms

In children and teenagers

The most common signs and symptoms of stroke include the sudden appearance of:

  • Weakness or numbness of the face, arm or leg, usually on one side of the body
  • Trouble walking due to weakness or trouble moving one side of the body, or due to loss of coordination
  • Problems speaking or understanding language, including slurred speech, trouble trying to speak, inability to speak at all, or difficulty in understanding simple directions
  • Severe headache especially with vomiting and sleepiness
  • Trouble seeing clearly in one or both eyes
  • Severe dizziness or loss of coordination that may lead to losing balance or falling
  • New appearance of seizures, especially if affecting one side of the body and followed by paralysis on the side of the seizure activity
  • Combination of progressively worsening non-stop headache, drowsiness and repetitive vomiting, lasting days without relief
  • Complaint of sudden onset of the "worst headache of my life"

In newborns and infants

  • Seizures
  • Extreme sleepiness
  • A tendency to use only one side of their body

When stroke affects a newborn infant, symptoms may not appear until 4 to 6 months of age in the form of decreased movement or weakness of one side of the body.

Watch the following video to learn about common signs and symptoms and what to expect during a stroke evaluation.

What you can do

  • Dial 911 or go to your nearest hospital Emergency Department.
  • Have your child lie flat.
  • Do not give your child anything to eat or drink.
  • Suggest that your local medical professional contact the CHOP Stroke Program for consultation. They may contact the CHOP operator at 215-590-1000 and ask for the Stroke team to be paged.

Reviewed by Rebecca N. Ichord, MD

Next Steps

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