What is a stroke?
Arteries and veins are types of blood vessels. Arteries carry fresh blood, oxygen and nutrients from the heart to all the tissues in the body, including the brain. Veins drain the blood from tissues, including the brain, back to the heart.
Stroke results from a sudden blockage of or damage to the blood vessels of the brain. This could stop the blood from flowing to a part of the brain, and as a result, less oxygen and other nutrients are able to reach that part of the brain. This can cause permanent damage to that part of the brain and stop it from working properly.
This page explains some of the possible causes of stroke in children, what tests may be used when stroke is suspected and available treatment options. The warning signs of stroke are also discussed.
Stroke can happen to anyone at any age. Strokes can happen in babies, children and teenagers, not just adults and seniors. Reasons for stroke in children are different from those in adults.
Finding the cause of the stroke is important:
- It helps decide what kind of treatment is best.
- It may help prevent more damage.
- It may stop your child from having another stroke in the future.
However, even after many tests, sometimes it is not possible to find out the exact cause of stroke.
A blood clot is the most common cause of stroke in children
A blood clot is the most common cause of strokes in children. A blood clot or clotting occurs when blood changes from liquid to solid form. Some blood clotting in the body is normal. But a blood clot that gets stuck in a blood vessel while moving through the body is not normal. If this happens in the brain, it can cause stroke.
A stroke caused by blockage of a blood vessel by a blood clot is called an ischemic stroke.
Blood vessels
Arteries and veins are both blood vessels in the body.
- An artery carries blood from the heart to the body’s tissues, including the brain.
- A vein carries blood from the body’s tissues back to the heart.
Because there are two kinds of blood vessels, there are two kinds of ischemic strokes:
- A stroke caused by a blood clot in an artery is called arterial ischemic stroke (AIS).
- A stroke caused by a blood clot in a vein is called cerebral sinovenous thrombosis (CSVT).
Arterial ischemic stroke
AIS can occur in either of the following ways:
- A blood clot forms in the body and travels to a blood vessel in the brain and gets stuck there. This is called an embolism.
- A blood clot forms directly in an artery that supplies blood to the brain. It blocks blood flow in that artery. This is called thrombosis.
Either way, a blood clot blocks the supply of blood to a part of the brain.
Detailed information on strokes caused by cerebral sinovenous thrombosis (CSVT) described briefly above, is available here.
Warning signs of arterial ischemic stroke
Warning signs of AIS in children, teenagers and young adults
Children, teenagers and young adults who are having a stroke may suddenly show one or more of these signs:
- They find that their face, arm or leg feels weak or numb, usually on one side of the body.
- They slur their speech, lose their ability to speak, or have trouble speaking and/or understanding simple statements.
- They cannot see clearly in one or both eyes.
- They have a new, very severe headache with or without vomiting (throwing up).
- They feel very dizzy like the room is “spinning”, lose their balance, have trouble walking or fall for no reason
Any of these can last for a few minutes to days, or they may have lasting effects.
Warning signs of AIS in babies
Babies may show only subtle signs of stroke, such as the following:
- Have seizures without a clear reason; for example, rhythmic jerking of one or more limbs.
- Have extreme trouble staying awake and alert during the day and outside of their normal sleeping time; in smaller babies, being drowsy and unable to wake for feeds.
- Prefer to use only one side of their body as they grow during their first year of life
One way to recognize some of the signs of stroke is to think of the acronym FAST.
- F for face drooping
- A for arm weakness
- S for slurred speech
- T for time to call 9-1-1
Possible causes of arterial ischemic stroke
About four out of 10 childhood strokes occur in children who are otherwise healthy. Some children may have problems with their blood clotting systems.
Other children may already have a serious condition that may lead to a stroke. These conditions include:
- heart disease which the child was born with (congenital) or acquires later, such as rheumatic heart disease
- heart or brain surgery
- sickle cell disease
- leukemia
- Moyamoya disease
- a problem with the system in the body's cells that turns food into energy; this is called metabolic illness
- blood clotting disorders
- serious infections, especially in the head and neck
- migraine headaches
- accidents involving the head and neck region
- other trauma
Common tests for childhood stroke
The health-care provider may order some or all of the following tests when a child has AIS.
Some of these are routine tests, which mean that they are done on many children throughout the hospital for many different reasons. If you want to learn more about an individual test your child is having, ask your health-care team for more detailed information.
Over time, most of these tests will be repeated to see how well your child is doing.
Computed tomography (CT) scan of the head
A CT scan takes pictures of the area in the brain where stroke has occurred. It may also show what kind of stroke has happened, and which parts of the brain are affected.
Magnetic resonance imaging (MRI)
An MRI is another way to take more detailed pictures of your child’s brain without X-rays. An MRI can show if a stroke occurred or not, often in more detail. It can also show when the stroke occurred, and the size of the injury. Younger children may require a general anaesthetic for an MRI scan as it takes longer and they need to stay still for at least 45 minutes.
A magnetic resonance angiogram (MRA) works the same way but looks at the arteries in the brain instead of brain tissue.
Echocardiogram
An echocardiogram uses sound waves to take a picture of your child’s heart. This is sometimes done as a blood clot may form in the heart and can travel up to the brain.
Bloodwork
Blood tests help the health-care team better understand why your child had a stroke. Children who need to take blood thinners may also need some blood tests to see:
- how well they are working
- if dosages need to be changed
Lumbar puncture
A lumbar puncture is also called a spinal tap. This test looks for signs of infection or inflammation in your child’s nervous system. It may be performed if the health-care team suspects infection or inflammation in the brain.
Cerebral angiogram
A cerebral catheter angiogram is a very detailed picture of the brain arteries. This is a special type of an X-ray of the head and a special dye is injected into the arteries. The dye makes the arteries show up on the X-ray.
Treating arterial ischemic stroke
These are the main goals in the treatment of AIS:
- Decrease the damage that the stroke can cause.
- Prevent another stroke from happening.
Treatments may include medicines called blood thinners, which help stop the blood from forming clots. Your child may receive one or more of the following blood thinners:
- warfarin given by mouth
- heparin, given intravenously
- low molecular weight heparin (LMWH), given by injections under the skin
- acetylsalicylic acid (ASA or Aspirin), given by mouth
- clopidogrel (Plavix), given by mouth
Rehabilitation for stroke
After stroke, some children may have difficulties with movement, balance, coordination, speech, learning, mood and behaviour. Rehabilitation therapy is very important to help these children recover. There are many different health-care professionals that may help your child. These include:
- physiotherapists
- occupational therapists
- speech language pathologists
- social workers
- neuropsychologists
Arterial ischemic stroke can happen again
The chance that a stroke will happen again depends on the cause of the stroke, as well as treatment at the time of the stroke. If the stroke occurred during the newborn period, your child is much less likely to have another stroke.
For more information
If you have any questions, please write them down so that your child's health-care team can answer them for you.
For more information about different types of stroke in children and babies, see Stroke in newborns, Childhood stroke: Cerebral sinovenous thrombosis (CSVT), Angiography and Imaging tests: X-ray, CT scan and MRI.