Learning About Ischemic Stroke in Children

A stroke is a brain injury. It occurs when blood flow is interrupted to part of the brain. A stroke caused by a blocked blood vessel is called an ischemic (say "iss-KEE-mick") stroke. The brain needs a constant supply of oxygen, which is carried by the blood. When blood flow stops, brain cells start to die.

Ischemic strokes are much more common in adults than in children. An ischemic stroke isn't expected in a child, so the diagnosis may be delayed. A child often recovers more abilities after an ischemic stroke than an adult does. That's because a child's brain is still developing.

There are many possible causes of an ischemic stroke in a child. A child is more at risk of this type of stroke if they have:

• A heart problem present at birth (congenital heart problem).
• Sickle cell disease.
• An infection such as meningitis or sepsis.
• A head injury.
• Injury from sports or accidents.
• Loss of too much fluid (dehydration).
• A blood clotting disorder such as factor V Leiden.
• A blood vessel condition such as dissection or vasculitis.
• High blood pressure.

In many children, no cause can be found.

Symptoms of an ischemic stroke depend on the child's age and the cause of the stroke.

A baby or young child may have:

• Seizures.
• Extreme sleepiness.
• A change in awareness.
• Use of only one side of the body.

Older children tend to have symptoms like those in adults. These can include:

• A severe headache, possibly with vomiting.
• Trouble with vision or moving the eyes.
• Weakness or numbness on one side of the body or face.
• Dizziness or sudden confusion.
• Loss of balance or coordination.
• Trouble walking.
• Trouble seeing.
• Trouble speaking or understanding words or sentences.
• Sleepiness or passing out (loss of consciousness).
• Seizure.
• Not being able to move one part of the body (paralysis).

The doctor will ask about your child's symptoms and health history. The doctor will ask about injuries, infection, problems with growth and development, and any family history of bleeding problems.

The doctor will give your child a physical exam. The doctor will look for weakness, numbness, and any other signs of an ischemic stroke.

Tests may include:

• Brain imaging tests. Brain imaging is done right away to confirm the diagnosis and determine treatment options. Magnetic resonance imaging (MRI) is the main test to diagnose ischemic stroke in children. A head CT scan may be done if MRI is not available. Magnetic resonance angiography may be done as part of the MRI. For this, a dye is injected to help show the blood vessels. Transcranial doppler or ultrasound may be done to look for problems in blood vessels in the brain.
• Blood tests. Blood is tested for signs of infection, sickle cell disease, blood vessel inflammation, and blood clotting problems.
• Heart and blood vessel studies. Heart rhythm is checked with an electrocardiogram (ECG). An ultrasound of the heart may be done to look for possible causes of air embolism or a blood clot. The child may need to wear a monitor for a few days or weeks to look for heart rhythm problems.
• Lumbar puncture (spinal tap). Cerebrospinal fluid (CSF) from around the brain and spinal cord may be examined for blood or signs of infection.
• Electroencephalogram (EEG). This test looks at the electrical activity of the brain. This is done to look for seizure activity.
• Pulse oximetry. This helps make sure there is enough oxygen in the blood.

Treatment works best if it's started as soon as possible. Treatment depends on the cause of the stroke. It may include:

• An intravenous (I.V.) tube to give medicines and replace fluids.
• Oxygen.
• A blood transfusion.
• Treatment to treat blood clots and to thin blood, such as:
  • Blood thinner medicines to help stop new clots.
  • A thin tube (catheter) used to remove a clot from a brain blood vessel in some children.
• Medicine to prevent seizures.
• Surgery for some causes.

There may be no way to prevent the first ischemic stroke in your child. A stroke can occur in children for many reasons, including conditions present at birth (congenital conditions). There's no way to prevent congenital conditions.

If your child has congenital heart disease or sickle cell disease, doctors will treat that condition. Treatment can help prevent future ischemic strokes. Your child may need tests over time to see if they're at high risk for more strokes.

Call 911 right away if your child has ischemic stroke symptoms.

B.E.F.A.S.T. is an easy way to remember the signs of stroke. When you see the signs, you will know that you need to call 911 fast.

• B is for balance: Sudden loss of balance or coordination.
• E is for eyes: Vision changes in one or both eyes.
• F is for face drooping: One side of the face is drooping or numb. When the child smiles, the smile is uneven.
• A is for arm weakness: One arm is weak or numb. When the child lifts both arms at the same time, one arm may drift downward.
• S is for speech difficulty: You may notice slurred speech or trouble speaking. The child can't repeat a simple sentence correctly when asked.
• T is for time to call 911: If a child shows any of these symptoms, even if they go away, call 911 right away. Make note of the time the symptoms first appeared.