Strokes

About Strokes

A stroke is a biological event (sometimes called a "brain attack") that happens when blood flow to the brain stops, even for a brief second.

Blood carries oxygen and other nourishing substances to the body's cells and organs, including the brain. When an ischemic stroke occurs, these important substances can't get to the brain and brain cells die. This can permanently damage the brain and cause a person's body to no longer function normally.

Strokes also can happen when a blood vessel in the brain breaks, flooding the brain with blood and damaging brain cells. This type of stroke, known as hemorrhagic, is uncommon in children.

Strokes in children most often happen between the 28th week of pregnancy, before a child is born, and 1 month after birth. Because they occur during the time surrounding birth, they're sometimes called perinatal strokes. Perinatal strokes usually occur during delivery or right after delivery because the baby doesn't get enough oxygen while traveling through the birth canal.

Strokes also can occur in older kids but are usually caused by another condition that stops the flow of blood to the brain or causes bleeding in the brain.

Causes

Determining the cause of a stroke in a child can be difficult. If your child has had a stroke, the doctor might not have definite answers for you, but can tell that a stroke occurred by using medical tests. About one third of all childhood strokes aren't related to any disease, condition, or injury that's known to increase the risk of stroke.

Ischemic strokes, the most common type in children, are usually related to:

• lack of oxygen during birth
• a heart defect present at birth
• blood disorders such as sickle cell anemia, a disease that destroys blood cells and blocks blood vessels
• injury to an artery (a blood vessel that brings oxygen) in the brain
• dehydration
• genetic disorders like Moyamoya, a rare disease that affects arteries in the brain
• an infection, such as meningitis or chickenpox

Certain problems that affect a mother during pregnancy can also cause a baby to have an ischemic stroke before or after birth. Examples include:

• preeclampsia (high blood pressure during pregnancy that can cause swelling in the hands, feet, and legs)
• premature rupture of the membranes (when a woman's water breaks more than 24 hours before labor starts)
• diabetes
• infections
• drug abuse
• placenta problems that decrease the baby's oxygen supply, such as placental abruption

Hemorrhagic strokes can be caused by:

• a head injury that results in a broken blood vessel
• arteriovenous malformation, a condition in which the blood vessels in the brain don't connect properly
• an aneurysm (weakness in an artery wall)
• diseases that affect blood clotting, such as hemophilia

Signs and Symptoms

Signs of stroke in children are often similar to signs in adults, which can include sudden weakness, slurred speech, or blurred vision. These effects vary widely depending on a child's age and the amount of damage to brain cells.

Children who experience a perinatal stroke often don't show any signs of the stroke until months or years later. In some cases, they develop normally, but at a much slower pace than other kids. They also might tend to use one hand more than the other when engaging in activities. Children who have more serious perinatal strokes, which cause more brain injury, might also experience seizures. The severity of seizures can vary, ranging from the child simply staring into space to violent shaking of only one arm or leg.

Signs of a stroke in infants:

• seizures in one area of the body, such as an arm or a leg
• problems eating
• trouble breathing or pauses in breathing (apnea)
• early preference for use of one hand over the other
• developmental delays, such as rolling over and crawling later than usual

A seizure may be the first sign that an older child or adolescent has had a stroke. These children might also experience sudden paralysis (inability to move) or weakness on one side of the body, depending on the area of the brain that's affected and the amount of damage the stroke causes. More likely, you'll first notice changes in your child's behavior, concentration, memory, or speech.

Common signs of stroke in kids and teens:

• seizures
• headaches, possibly with vomiting
• sudden paralysis or weakness on one side of the body
• language or speech delays or changes, such as slurring
• trouble swallowing
• vision problems, such as blurred or double vision
• tendency to not use one of the arms or hands
• tightness or restricted movement in the arms and legs
• difficulty with schoolwork
• memory loss
• sudden mood or behavioral changes

If your child experiences any of these symptoms, see a doctor right away, or dial 911. In kids who are actively having a stroke, medicine can be given to potentially reduce the severity of the stroke and brain damage caused.

Diagnosis

Perinatal and early childhood strokes can sometimes be hard to diagnose, especially if a child has no obvious signs or symptoms. In some cases, a stroke is found to be the cause of seizures or developmental delays only after many other conditions have been ruled out. This might mean that a child will undergo several tests before the doctor even mentions the word "stroke."

If stroke is suspected, a doctor will probably want the child to undergo one or more of these medical tests:

• blood tests
• magnetic resonance imaging (MRI), a safe and painless test that uses magnets, radio waves, and computer technology to produce very good pictures of internal body parts, such as the brain
• magnetic resonance angiography (MRA), an MRI of specific arteries
• magnetic resonance venography (MRV), an MRI of specific veins
• computed tomography scan (CT or CAT scan), a quick and painless test that produces pictures of bones and other body parts using X-rays and a computer
• computed tomography angiography (CTA), an X-ray of specific arteries
• cranial ultrasound, high-frequency sound waves that bounce off organs and create a picture of the brain
• lumbar puncture, also called a spinal tap

Treatment

Treatment for a stroke is determined by how old the child is, what signs and symptoms he or she experiences, which area of the brain is affected, how much brain tissue was damaged, and whether another ongoing condition was the cause of the stroke.

Many different treatments are possible. For example, a child who is having seizures may require anti-seizure medications, whereas a child with a heart defect might need medication to thin the blood. For most kids, treatment also involves age-appropriate rehabilitation and therapy.

Complications

The brain damage that occurs during a stroke can cause a number of other problems that could affect a child throughout life, including:

• cerebral palsy
• mental retardation
• paralysis or weakness on one side
• communication problems
• vision deficits
• psychological difficulties

Kids who've had a stroke will see doctors who specialize in helping people cope with these problems. These specialists might include occupational, physical, and speech therapists. A child's care might be overseen by a neurorehabilitation specialist, a doctor who uses many different types of therapy to help children recover from stroke.

Outlook

At this time, no treatment exists that will fix brain cells that have died. However, one amazing thing about the brain is that undamaged brain cells can learn to perform the jobs of cells that have died, especially in young people.

In many cases after a stroke, kids can be taught to use their arms and legs and speak again through brain retraining. Although this process is usually slow and difficult, children have an edge over adults because their young brains are still developing. Most kids who have had strokes are able to function normally in society and grow to be productive members of their communities.

Don't be afraid to ask questions about your child's condition or treatment or to ask for help when you need it. You aren't facing your child's stroke, rehabilitation, and future care alone. In addition to the doctors and therapists who will be working with your child, look for support groups for parents of kids who have had strokes and for those who have a risk of additional strokes or permanent disabilities. It can be helpful to seek support from other parents facing the same challenges.

Reviewed by: Harry S. Abram, MD
Date reviewed: January 2010