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 or clotting occurs when blood changes from liquid to solid form. A certain amount of blood clotting in the body is normal. However, a blood clot that gets stuck in veins or the brain is not normal. If this happens in the brain, it can cause a stroke.
A stroke caused by blockage of a blood vessel by a blood clot is called 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). Detailed information on AIS is available here.
- A stroke or brain swelling caused by a blood clot in a vein is called cerebral sinovenous thrombosis (CSVT).
- In some cases, you may have a CSVT but you may not have had a stroke.
Cerebral sinovenous thrombosis
CSVT is a type of ischemic stroke caused by a blood clot in a vein.
Some of the warning signs of CSVT
Children, teenagers and young adults who are having a stroke due to CSVT may gradually or suddenly show one or more of the following signs:
- They slur their speech, cannot speak at all, or have trouble speaking and understanding simple statements.
- They cannot see clearly in one or both eyes.
- They experience confusion or become less conscious.
- They have a new, severe headache, with or without vomiting (throwing up).
- They find that their face, arm or leg feels weak or numb, usually on one side of the body.
Babies who are having a stroke due to CSVT may only show the following signs:
- They have seizures without a clear reason. Seizures may look like twitching of the face, arms or legs, or staring spells.
- They have extreme trouble staying awake and alert during the day outside of their normal sleeping time.
Possible causes of cerebral sinovenous thrombosis
Sometimes, CSVT occurs in otherwise healthy children. For other children, CSVT may be caused by another condition the child already has. Possible causes of CSVT include the following:
- dehydration or not having enough fluid in the body
- worsening head and neck infections
- leukemia and medications that are used to treat leukemia
- blood clotting disorders
- head trauma
- iron deficiency anemia
- taking birth control pills that contain estrogen
- other childhood diseases (i.e., genetic causes)
Common tests for childhood stroke
The health-care team may order some or all of the following tests when a child has CSVT.
Some of these are routine tests. This means they are done on many children in the hospital for different reasons other than stroke. If you want to learn more about a certain test your child is having, ask your health-care team for more detailed information.
Most of these tests will be done several different times, to see how well your child is doing over time.
Physical exam (neurological exam)
A neurological exam looks at how well your child's brain is working. For example, how well the brain is sending messages to the body.
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.
A CT venogram (CTV) will take a detailed look at the veins inside the brain.
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 venogram (MRV) will take a closer look at the veins in the brain.
Bloodwork
Blood tests help the health-care team better understand why your child had a stroke. If your child is taking blood thinners, tests will be done to find out how well they are working. Tests may show that the dose needs to be changed.
Lumbar puncture
This test looks for signs of infection or inflammation in your child's nervous system. These conditions may have caused the stroke. A lumbar puncture is also called a spinal tap. It may be performed if the health-care team suspects infection or inflammation in the brain.
Treating cerebral sinovenous thrombosis
The main goals in the treatment of CSVT are as follows:
- Decrease the brain damage that the CSVT can cause.
- Prevent the blood clot from getting bigger.
Treatments may include medicines called blood thinners (anticoagulants). These help stop the blood from forming more clots. Your child may receive one or more of the following blood thinners:
- warfarin, given by mouth
- heparin, given by intravenous
- low molecular weight heparin (LMWH), given by injection under the skin
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
Cerebral sinovenous thrombosis 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.
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 or babies, see Stroke in newborns, Childhood stroke: Arterial ischemic stroke and Imaging tests: X-ray, CT scan and MRI.