Stroke in Children

What is a pediatric stroke?

Stroke is a general term that is used to describe an injury to the brain caused by either bleeding (referred to as hemorrhagic stroke) or a lack of oxygen due to vessel obstruction (referred to as ischemic stroke). A stroke usually implies some type of permanent injury to the brain. The term infarct or infarction may also refer to a stroke. When a stroke occurs in a newborn, it is called a neonatal stroke.

Stroke can occur at any time in a child's life. After the newborn period (the first 28 days of life), stroke is more rare but can impart lifelong disability and in some instances can be fatal. This makes early recognition and treatment vitally important.

Kids aren’t just little adults — they have different signs and symptoms of stroke and require specialized pediatric care. This animated video can help both kids and adults understand why strokes happen and how we treat them at Boston Children’s Hospital.

What causes stroke in children?

Brain cells are incredibly delicate and require a steady supply of oxygen and other nutrients such as glucose. Even brief interruptions in the delivery of oxygen can cause injury. Strokes are caused by three main mechanisms:

  • The blood supply to the brain may be blocked. This may occur when a tiny clot (called an thromboembolus) plugs a blood vessel in the brain. This can happen in a number of conditions of childhood and thorough evaluation is required, which the team at the Stroke and Cerebrovascular Center can provide. In addition, the vessels themselves may be narrowed, reducing the amount of blood delivered to the brain, as is seen in childhood cerebral arteriopathy. Moyamoya disease is an example of cerebral arteriopathy.
  • The blood may not contain enough oxygen. This may occur in cases when a child can't breathe for long periods of time or has carbon monoxide poisoning. Alternatively, if the heart isn't beating appropriately, the blood may not circulate fast enough to bring fresh blood with oxygen to the brain.
  • The brain might be under pressure. This can occur when the brain swells after trauma or when there is bleeding around the brain. There may be bleeding within the brain itself, which directly injures the brain tissue and also makes it harder for blood with oxygen to be delivered to it. This increased pressure often prevents oxygenated blood from the heart from entering the confines of the skull.

In all of these cases, the injury to the brain tissue and the lack of oxygen cause some of the brain cells to die, resulting in a stroke. Childhood stroke can be associated with congenital heart disease, abnormalities in blood vessels, disorders that increase the blood's tendency to clot, infection, or inflammation. Strokes occur more often in boys than girls and more often in African Americans than in Caucasians.

What are the symptoms of a pediatric stroke?

Stroke symptoms vary widely depending on which part of the child's brain has been injured. Some parts of the brain can suffer stroke with little or no recognizable symptoms, referred to as "silent" strokes. Other strokes, even very small ones, can cause significant disability, such as paralysis, blindness, cognitive compromise, or even death, if they occur in sensitive areas of the brain.

If you see any of these symptoms in your child, go directly to an emergency room immediately:

  • weakness on one side of the body
  • difficulty speaking
  • difficulty walking or instability when standing
  • vision loss
  • first-time seizure
  • a change in mental state

Short episodes of weakness or numbness on one side of the body, difficulty speaking, or a sensation that the room is spinning may mean your child is having a transient ischemic attack (TIA), a possible warning sign of stroke that requires immediate evaluation in an emergency room.

Meet our pediatric stroke patients

Charlie is one of the many stroke patients treated by the team at Boston Children’s Hospital.

How we care for stroke in children

The diverse team of specialists in the Stroke and Cerebrovascular Center at Boston Children's Hospital provides fast, comprehensive evaluation to identify quickly if and why a stroke has occurred. We are skilled in administering therapies in the earliest stages of stroke that are designed to remove blockages of blood vessels in the brain.

If the stroke is caused by malformations of the blood vessels in the brain, our team can treat your child using surgical- or catheter-based techniques.

Our team approach means that your child will benefit from the combined expertise of child neurologists, pediatric neurosurgeons, hematologists, pediatric physiatrists, neurointerventional radiologists, pediatric neuroradiologists, emergency medicine physicians, neuropsychologists, physical and occupational therapists, and speech and language therapists. We also offer long-term multidisciplinary care to help prevent additional strokes in the future.