Stroke | Diagnosis & Treatment

How are strokes diagnosed?

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. Diagnostic procedures we use to diagnose stroke include:

  • imaging of the brain and blood vessels in the head and neck using MRI, CT and catheter angiography
  • 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
  • genetic studies to look for hereditary risk factors for blood clots a transcranial ultrasound assessment to assess blood flow in the brain

These assessments allow clinicians to take steps to prevent stroke from recurring.

What are the treatment options for stroke?

The treatment of a stroke has two parts:

Immediate treatment for stroke

When treating an acute stroke, your doctor will quickly assess whether clot-busting (thrombolytic) medicine, such as tissue plasminogen activator (tPA), or thrombectomy is appropriate for your child. Previously used only in adults, this treatment can open up blood vessels obstructed by blood clots and limit the stroke's effect on the brain. Currently tPA must be given within the first 4½ hours after onset of symptoms to be effective.

In some critically ill patients, your doctor may perform endovascular thrombectomy. This treatment involves navigating a very small catheter directly into the area of the clot and removing the clot itself.

When thrombus removal isn't an option, the 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.

Long-term care for stroke

Regardless of the cause, the problems that result from the stroke (such as weakness and numbness) often improve with therapy over time. After the acute period has passed, children are closely followed by the Boston Children's Hospital Stroke and Cerebrovascular Center outpatient program, under the care of a child neurologist, hematologist, physiatrist, neuropsychologist and neuroradiologist as well as occupational and physical therapists.

Our team 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 and language therapies or a combination of these. Continuing neurosurgical and neuroradiologic care are also available.

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 an experienced neuropsychologist, provide a profile of cognitive function and lead to specific recommendations for how to best structure the child's educational program.