Pediatric Stroke

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.

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 (hem-or-aj-ick).
• Ischemic stroke (is-keem-ick).
• 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.

What are pediatric stroke symptoms?

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

• 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).

But 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. There are two different kinds of stroke:

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

Causes of pediatric stroke include:

• Blood vessel malformations that increase the risk of bleeding in your child’s brain, such as arteriovenous malformation (AVM). Your child may be born with these malformations.
• Congenital heart disease, a group of heart conditions that may be present at birth.
• Blood disorders that may increase the risk of blood clots or brain bleeds, like 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.

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?

Providers use several tests to diagnose stroke, depending on your child’s symptoms. These include:

• CT scan (computed tomography scan) of their head to check for a brain bleed or an area of their brain affected by a blood clot. It’s a quick test and widely available.
• CT angiogram to check how blood flows through their heart, blood vessels and brain.
• Brain MRI (magnetic resonance imaging) to help providers visualize the structure of your child’s brain and blood vessels. It’s the most sensitive test to diagnose a stroke.
• Magnetic resonance angiogram (MRA) to show providers how blood flows.

Other tests used to diagnose the cause and complications of seizures include:

• Echocardiogram (Echo) to check your child’s heart structure.
• Electroencephalogram (EEG) to determine if they’re experiencing seizures.
• Blood tests to determine if they have sickle cell disease or conditions that cause blood clots.
• Genetic testing if certain genetic disorders are the suspected cause of the stroke.

What is the treatment for pediatric stroke?

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):

• For ischemic strokes, providers often use medications like thrombolytics (or possibly a procedure called thrombectomy) to restore blood flow to your child’s brain.
• For hemorrhagic strokes, surgery may be necessary to control the bleeding.

Is there a pediatric stroke protocol?

A stroke protocol is a series of actions to diagnose and treat strokes in a timely manner. Each hospital has a protocol for pediatric stroke.

What other medications do providers use to treat pediatric stroke?

Your child may have anticoagulant medications to thin their blood. Providers may also use antiseizure medications if your child has seizures.

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. Talk to your healthcare provider about your child’s condition and how you can help them stay healthy.

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

Are there conditions during pregnancy that increase the risk of pediatric stroke?

Sometimes, ischemic strokes occur during birth or soon after a baby is born, called perinatal strokes. Some conditions that occur during pregnancy can increase your baby’s stroke risk, including:

• Gestational diabetes.
• Preeclampsia.
• Premature rupture of membranes.

Talk to your healthcare provider about steps you can take to reduce your risk of pregnancy complications.

How can I lower my child’s risk of pediatric stroke?

Talk to your healthcare provider about your child’s stroke risk. Some children take medications to help prevent blood clots, which helps prevent stroke.

How long does it take to recover from pediatric stroke?

Each child’s recovery is different. Your child will likely have pediatric stroke rehabilitation after a stroke. Depending on their symptoms, they may receive care from a team of specialists. They may see a:

• Pediatric neurologist.
• Pediatric cardiologist.
• Pediatric hematologist (a provider who specializes in blood, bone marrow and lymphatic system diseases).
• Pediatric neurosurgeon.
• Physical therapist.
• Speech-language pathologist (SLP).
• Occupational therapist for pediatric occupational therapy.

What is the survival rate for a pediatric stroke?

Researchers studying pediatric stroke have found that delayed diagnosis can affect health outcomes. Many children who have ischemic stroke survive. But they may be at risk for another stroke, especially if they have heart problems or blood clotting disorders.

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

Talk to your healthcare provider about your child’s health. Your child may need stroke rehabilitation. Follow your provider’s instructions and make sure 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.

When should my child see a healthcare provider?

Your child may need care from a team of specialists after a stroke. Take your child to all scheduled appointments with their providers. Call your provider if you have any concerns about your child’s health or development, especially if you notice new symptoms.

When should my child go to the ER?

If your child has stroke symptoms, call 911 immediately. A stroke is an emergency. Getting care right away can improve your child’s health outcomes.

A note from Cleveland Clinic

Pediatric strokes are rare. But when they happen, getting treatment right away can make a big difference in your child’s recovery. Learn the signs of stroke in children and call 911 if your child has symptoms. Talk to your provider about what you can do to protect your child if a medical condition increases their stroke risk.