Although most strokes occur in adults, they can happen at any age. Strokes in kids are uncommon — and they can be hard to diagnose.
Strokes in kids can have lifelong neurological effects, but proper diagnosis and treatment can help kids recover.
Learn more about pediatric strokes.
Are Strokes Common in Kids?
About three or four kids out of every 100,000 have a stroke yearly in the United States.
Neonates and newborns are most at risk of a stroke. When strokes happen in this age group, doctors call it a perinatal stroke.
“We typically think of stroke as kind of a similar incidence to brain tumors in children,” says Dr. Dana Cummings, MD, director of the Pediatric Stroke Program at UPMC Children’s Hospital of Pittsburgh. “Certainly, in all of childhood, the highest-risk time is probably late in pregnancy and early in infancy.”
Often doctors do not diagnose perinatal strokes until months or years later when the child shows neurological effects.
Although rare, strokes are among the top 10 leading causes of death in kids in the U.S.
What Causes Strokes?
Strokes happen when something disrupts blood flow to part of the brain. A stroke — which can be referred to as a pediatric brain attack — results when the affected part of the brain does not get enough blood supply, oxygen, and nutrients. Brain cells in that area begin to die.
Genetic, environmental, and congenital differences can raise your child’s risk of stroke.
- Genetic factors. Sickle cell disease, clotting disorders, and other health issues increase risk.
- Environmental factors. Infections, medications, carbon monoxide poisoning, trauma, and other environmental causes can lead to stroke.
- Congenital causes. Abnormalities in the development of the blood supply to the brain can lead to stroke during fetal life or blood vessel malformations — including arteriovenous malformations or cerebral aneurysms that can bleed — during childhood. Some children develop Moyamoya disease, a progressive narrowing of large blood vessels that supply the brain, which leads to strokes.
Dr. Cummings says doctors are studying causes of stroke specific to kids. There is a group of children who appear to develop inflammation and blockage of blood flow in large, important arteries in the brain after minor infections.
“We’re continuing to study whether it’s some very special virus or bacteria or something that triggers that or if the child has an unusual immune response to that kind of event,” Dr. Cummings says.
Types of Strokes
There are two main types of strokes in kids:
- Ischemic stroke. This happens when something — usually a clot — in one of the brain’s blood vessels blocks blood flow. There are two types of ischemic stroke in kids. Sinovenous thrombosis stroke is a clot in a vein, while arterial ischemic stroke is a clot in an artery.
- Hemorrhagic stroke. This happens when a blood vessel in or near the brain bursts and causes a bleed in the brain.
“Both of those can present with what we call brain attack symptoms,” Dr. Cummings says. “Whereas in adults it’s probably about 85% ischemic strokes and 15% hemorrhagic strokes, it’s more of a 50/50 split in children.”
Signs and Symptoms of Pediatric Stroke
Many of the symptoms of stroke in kids are similar to those in adults. One specific warning sign — seizure — is much more common in kids. Common symptoms of pediatric strokes include:
- Trouble talking.
- Loss of balance or trouble walking.
- A numb or weak feeling in the face, arm, or leg on one side of the body.
- Prolonged loss of consciousness.
- Vision problems, such as double vision or loss of vision.
- Lethargy.
- Sudden, severe headache.
- Neck pain.
- Vomiting.
- Shaking or sudden jerks of the body that the child can’t control.
“In young children, especially under age 3, seizure can be the first sign of an ischemic stroke,” Dr. Cummings says. “The possibility of stroke presenting as seizures is especially challenging for health care providers because childhood and infancy are a time of a high rate of seizures. So, one of our tasks in the Emergency Department is often to be thinking about whether this child or infant presenting with a seizure could have an ischemic or hemorrhagic stroke.”
If you notice your child has any of the above symptoms, call 911. One way you can keep track of stroke symptoms is through the acronym BE FAST:
- B for a sudden loss of balance.
- E for eyes (vision problems).
- F for face (face drooping).
- A for arms (one arm weak or numb).
- S for speech (slurred speech).
- T for time (call 911 right away).
Beyond BE FAST, Dr. Cummings says to call 911 if your child has a seizure, shows strange symptoms, or starts acting odd.
“Parents have great wisdom; if a parent is alarmed by a new onset change in behavior, then they should seek immediate medical attention,” he says. “Taking advantage of our EMS system and our network of emergency care is important. We’re here to offer rapid evaluation to determine whether this is a cerebral vascular emergency or some other kind of neurologic syndrome.”
Diagnosing Strokes in Kids
It can be hard to diagnose strokes in kids, especially with a perinatal stroke. Kids with a stroke before, during, or soon after birth may not show neurological symptoms until later when they begin to use their arms and legs in purposeful ways.
To diagnose a stroke in a child, doctors may order:
- Brain images with magnetic resonance imaging (MRI) or computed tomography (CT) scans.
- Blood tests to check for clotting or other disorders.
- Heart scans to check for heart problems.
- Electroencephalograms
to look for evidence of seizure tendencies or encephalitis.
Treatment for Pediatric Strokes
Your child’s care plan will depend on many factors, including the type of stroke, when it happened, and related causes. Treatment may include:
- Emergency treatment to mechanically remove a clot blocking a major artery in the brain.
- Blood thinner medication to decrease short-term risk of another stroke.
- Emergency surgery for intracranial hemorrhage.
In adults, the clot-busting drug tissue plasminogen activator (tPA) is an option when given quickly. While the long-term benefit of tPA in children might not be as large as in adults, our best evidence suggests that it can be safely used in children.
One relatively novel treatment available through our interventional neurologists and neurosurgeons is a endovascular thrombectomy (EVT), also known as mechanical thrombectomy. By passing special catheters through the main arteries in the trunk and chest to the blood supply of the brain, stroke-causing clots can be removed. These kinds of procedures help reduce damage when used even up to 24 hours after a stroke onset.
After these initial stroke treatments, your child may remain on aspirin or blood thinners to prevent another stroke. Rehabilitation — including physical, occupational, and speech therapy — also is often needed.
Do Kids Recover from Strokes?
Kids generally recover better after strokes than adults — but every child’s recovery differs. Kids can recover fully with quick diagnosis, effective treatment, and rehabilitation. Others may show long-term effects, including:
- Weakness on one side of the body.
- Speech problems.
- Cognitive changes.
- Behavioral changes.
- Post-stroke epilepsy.
Some evidence shows strokes may be more disruptive in children less than one year of age, Dr. Cummings says. In children with well-established brain networks, the brain can make best use of plasticity to “rewire” itself.
“Before age 2, maybe the strokes that happened earlier on are disrupting the organization of the brain,” he says. “Whereas beyond age 2, once the brain is well-organized, then the plasticity mechanisms can be used to greater effectiveness.”
About the UPMC Children’s Pediatric Stroke Program
The Pediatric Stroke Program at UPMC Children’s Hospital of Pittsburgh’s Brain Care Institute offers world-class care for strokes in kids. Our combined team includes child neurologists, vascular neurologists, interventional stroke neurologists, and neurosurgeons.
We provide comprehensive care, including the most advanced techniques to diagnose and treat strokes. We are leaders and international collaborators in research to understand strokes in kids better.
You need a referral to the Pediatric Stroke Program. To schedule a visit once you have a referral, call 412-692-5520. To learn more about our program, visit us online.
Editor's Note: This article was originally published on , and was last reviewed on .