Stroke and Cerebrovascular Center | Stroke and Cerebrovascular Care

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Contact the Stroke and Cerebrovascular Center

  • 1-617-355-6388
  • International: +1-617-355-5209

Our inpatient team is available 24 hours per day, 7 days per week to rapidly evaluate and treat children with signs of acute stroke. We then follow children throughout their hospitalization to make sure that the right medicines and therapies, such as physical, occupational, speech/language and other cutting edge therapies, are started. If rehabilitation treatment is needed after hospitalization, we will ensure that there is a seamless transfer of care.

Stroke Center Boston Children's Hospital

Diagnosis and acute care of children with stroke

Our care begins even before a child arrives to our Emergency Department. The Boston Children’s Hospital Transport team cooperates with other emergency rooms and hospitals in and around New England to quickly transfer children with symptoms of acute stroke to Boston Children’s acute stroke center.

During the acute period—soon after a stroke has started—our first priority is to diagnose the underlying cause. We carefully image the brain to determine the extent of the stroke and which areas of the brain are affected. We also quickly assess whether clot-busting (thrombolytic) medicine, such as tissue plasminogen activator (tPA), is appropriate for the child. Previously used only in adults, this cutting-edge treatment, if given within the first 4½ hours after onset of symptoms, can open up blood vessels obstructed by blood clots and limit the stroke’s effect on the brain.

In some critically ill patients, we may perform endovascular thrombolysis. This treatment involves navigating a very small catheter directly into the area of the clot and delivering clot-dissolving drugs like tPA .

When thrombolytic treatment isn’t an option, our goal is to provide the best neuroprotective care possible to limit further damage to the brain. This care focuses on maintaining high blood oxygen levels and optimal blood pressure, to ensure the brain receives the blood flow and oxygen it needs, and controlling blood glucose levels and treating fever, which can exacerbate injury to the brain from stroke.

Diagnostic assessment for acute stroke proceeds on several fronts simultaneously and includes:
  • imaging of the brain and blood vessels in the head and neck using MRI (magnetic resonance imaging), CT (computed tomography) and catheter angiography protocols designed here at Boston Children’s
  • a cardiology evaluation to look at the heart for possible cardio-embolic causes of stroke
  • blood tests, including a panel of tests associated with bleeding or clotting disorders (thrombophilia testing), inflammatory disorders or metabolic disorders (see below)
  • genetic studies to look for hereditary risk factors for blood clots
  • a transcranial ultrasound assessment to assess blood flow in the brain

These assessments, tailored to each child’s case, allow us to take steps to prevent stroke from recurring. For example, some causes of stroke, such as malformations of the blood vessels in the brain, can be treated by the Cerebrovascular Surgery and Interventions Center using surgical or catheter-based techniques.

Thrombophilia, metabolic and genetic testing

Our panel of testing for bleeding/clotting disorders includes:

  • tests for activated protein C resistance (screening test for factor V Leiden)
  • prothrombin gene mutation G20210A testing
  • functional testing for antithrombin, protein C and protein S, lipoprotein-a, fasting homocysteine and antiphospholipid antibodies, including lupus anticoagulant, cardiolipin and beta-2 glycoprotein-1 antibodies 

Other testing may investigate von Willebrand factor antigen, factor VIII activity, D-dimer, erythrocyte sedimentation rate or C-reactive protein. Our program hematologist will review and interpret any abnormal results on these tests. The results may provide important information about genetic risk factors carried by multiple family members and clues about a child’s stroke risk in the future. Often, abnormal results require confirmatory testing before a diagnosis can be made, and may not change the medications recommended for treatment or prevention of stroke. 

Metabolic testing, when appropriate, can include lactate, pyruvate and individual amino acid measurements and other tests.  In some cases, we may offer genetic testing for familial hemiplegic migraine or connective tissue disorders.

Long-term and outpatient care of stroke

Weekly clinics

After the acute period has passed, children are closely followed by our outpatient program, under the care of a child neurologist, hematologist, physiatrist, neuropsychologist, neuroradiologist as well as occupational and physical therapists. We offer weekly clinics to meet our patients’ needs and answer any questions. Follow-up neuroimaging and laboratory studies are done as needed and reviewed in advance of the clinic visits.

The stroke team also creates a comprehensive rehabilitation plan for each child to address the long-term consequences of the stroke. This can involve physical, occupational, vision or speech/language therapies, or a combination of these. Continuing neurosurgical and neuroradiologic care are also readily available.

Education planning

Stroke can very suddenly change a child’s learning profile and school performance. Each child in the Stroke and Cerebrovascular Center receives neuropsychological evaluations to inform academic planning. These assessments, conducted by neuropsychologist Christine Mrakotsky, MD, provide a profile of cognitive function and lead to specific recommendations for how to best structure the child's educational program. 

Family support

The Stroke and Cerebrovascular Center can connect you with other families whose child has had a stroke via our partner, the Children’s Stroke Foundation.

Boston Children’s is so much more than a hospital—it’s a community of researchers, clinicians, administrators, support staff, innovators, teachers, patients and families, all working together to make the impossible possible. ”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital
300 Longwood Avenue, Boston, MA 02115
For Patients: 617-355-6000
For Referring Providers: 844-BCH-PEDS | 844-224-7337