Pediatric Strokes Are More Common Than You Think

Medically reviewed by Andrea C. Pardo, MD, FAAP, Divison of Neurology and Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program

Childhood or pediatric stroke affects about 1 in 40,000 children in the US. Most children are diagnosed with stroke during early childhood, before age 5, although strokes may happen at any age from childhood to adulthood.¹ Although pediatric stroke is a relatively rare occurrence, symptoms should be evaluated promptly by healthcare providers because their symptoms are similar to other conditions, like pediatric migraine, pediatric seizures or intracranial hemorrhage. 

What are the symptoms of pediatric strokes?

Strokes in childhood may mimic more common diseases such as migraine, epilepsy, brain infections or tumors with symptoms of headache, seizures and inability to walk or talk. Because of this, it's very important to seek immediate medical attention to rule out the presence of a stroke. 

In particular, children experiencing the following symptoms need timely care:  

• Balance issues 
• Sudden vision loss or double vision
• Facial drooping
• Arm weakness or numbness
• Difficulty with speech
• New onset seizures  

When evaluating a child with these symptoms, our neurologists keep stroke in mind as a potential cause. Children with symptoms of stroke require neuroimaging with a head computerized tomography (HCT) or magnetic resonance (MRI) to make a diagnosis. Our team works with the doctors in the emergency department to recognize strokes quickly. Prompt diagnosis may provide the opportunity to treat strokes in children soon after the onset of symptoms.³

If a stroke is diagnosed in a pediatric patient, treatment may depend on the timing of the stroke. Most children with stroke are admitted to the pediatric intensive care unit for close monitoring, secondary injury prevention and testing to determine the cause of the stroke. The critical care team works closely with experts from our Ken M. and Ruth D. Pediatric Neurocritical Care Program.

What causes pediatric strokes? What are the risk factors?

Pediatric stroke has been associated with risk factors such as sickle cell disease, congenital heart disease, hypercoagulability syndromes, arteriopathies or genetic syndromes. However, previously healthy children may also suffer from strokes. Strokes in previously healthy children may be with local abnormalities in the blood vessels or related to recent infections.² These blood vessel abnormalities may lead to strokes due to decreased blood flow and the formation of clots. Tears in the lining of the blood vessels due to trauma may also cause strokes. Children with pediatric stroke will require a thorough investigation to identify potential risk factors and causes of stroke.⁵ 

How are pediatric strokes treated?

When a child is diagnosed with stroke, our pediatric neurocritical care team⁴ in conjunction with the pediatric intensive care unit, teams provide comprehensive evaluation and treatment to improve outcomes. Finding the cause of a stroke will also help determine the risk of recurrence. Children may have recurrent strokes in up to 10% of cases, with the highest risk of recurrence around 1 year after their first stroke. Some children may require a blood thinner to reduce the likelihood of a recurrent stroke for 2 years or longer after their stroke.  

Children with stroke are followed closely in our outpatient clinic, and our team works closely with our rehabilitation specialists for the best outcome possible. Our team actively participates in StrokeNET, a multicenter research initiative lead by the National Institutes of Health. The goal of StrokeNET is to advance stroke treatment, prevention, recovery and rehabilitation.  

What is neonatal stroke?

Neonatal stroke occurs in 1 in 1100 live births and is a very common occurrence. Symptoms may be apparent shortly after birth with seizure-like activity. This includes jerking of the arm or leg and oftentimes twitching of the face with or without eye deviation. If these symptoms are present, our team will use neuroimaging with magnetic resonance (MRI) to diagnose a stroke. Our Neonatal Intensive Care Unit (NICU) and Fetal & Neonatal Neurology Program care for neonates with stroke.

Occasionally, neonatal stroke may present without symptoms in the first few months of life and may only be noted when children develop an early hand preference or an asymmetric pattern of crawling. Neuroimaging with an MRI is necessary to diagnose a stroke.

Unlike childhood stroke, neonatal stroke is unlikely to happen again. However, it is important that babies that have been diagnosed with stroke get enrolled in therapies and are closely monitored for development to maximize their outcome.     

Pediatric Stroke Recovery

Babies and children with stroke require developmental follow-up and rehabilitation to maximize their function after a stroke. Physical therapy, occupational therapy and speech therapy may be needed to improve outcomes. Our Neurovascular Disease and Stroke Program will follow children diagnosed with stroke. Lurie Children’s is also a site for I-ACQUIRE, the first randomized controlled trial for constraint-induced movement therapy for infants who have been diagnosed with stroke in the neonatal period.

Learn more about Lurie Children’s Neurocritical Care Program

References

1. Lehman LL, Khoury JC, Taylor JM, Yeramaneni S, Sucharew H, Alwell K, Moomaw CJ, Peariso K, Flaherty M, Khatri P, Broderick JP, Kissela BM, Kleindorfer DO. Pediatric Stroke Rates Over 17 Years: Report From a Population-Based Study. J Child Neurol. 2018 Jun;33(7):463-467. doi: 10.1177/0883073818767039. Epub 2018 Apr 19. PMID: 29673287; PMCID: PMC5935572.
2. Fullerton HJ, Hills NK, Elkind MS, et al. Infection, vaccination, and childhood arterial ischemic stroke: Results of the VIPS study. Neurology. 2015;85(17):1459-1466.
3. Sun LR, Felling RJ, Pearl MS. Endovascular mechanical thrombectomy for acute stroke in young children. J Neurointerv Surg. 2019;11(6):554-558.
4. Wainwright MS, Grimason M, Goldstein J, et al. Building a pediatric neurocritical care program: a multidisciplinary approach to clinical practice and education from the intensive care unit to the outpatient clinic. Semin Pediatr Neurol. 2014;21(4):248-254.
5. Fullerton HJ, Wintermark M, Hills NK, Dowling MM, Tan M, Rafay MF, Elkind MS, Barkovich AJ, deVeber GA; VIPS Investigators. Risk of Recurrent Arterial Ischemic Stroke in Childhood: A Prospective International Study. Stroke. 2016 Jan;47(1):53-9. doi: 10.1161/STROKEAHA.115.011173. Epub 2015 Nov 10. PMID: 26556824; PMCID: PMC4696877.

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