Most people think of strokes as adult medical emergencies, but children and adolescents can suffer from them, too. A pediatric stroke, or cerebrovascular disorder, can affect one side of the brain and cause speech and language problems, movement and balance challenges and other behavioral changes. Early recognition and treatment can reduce long-term disabilities.

Most of the time, a stroke is caused by a blood clot that blocks or restricts oxygen flow to a part of the brain. The two types of stroke are ischemic (from blockage) and hemorrhagic (from bleeding). One of the core components of Advanced Stroke Life Support is training healthcare providers to recognize the various signs and symptoms of stroke. This includes understanding the differences between ischemic and hemorrhagic strokes and recognizing "stroke mimics" – conditions that can present similar symptoms but are not strokes.

The signs of a stroke can vary, but often include trouble walking or speaking, and the face is drooping on one side. Other signs include sudden numbness or weakness, difficulty seeing, and a troubled expression. A child’s growing brain is less likely to have permanent damage from a stroke than an adult’s, but quick identification and treatment are key to good outcomes.

While many first responders are familiar with the FAST acronym to identify patients with possible ischemic stroke, few first aid programs teach that children can also experience this condition. In addition, few medical providers are trained in the proper use of the pediatric National Institutes of Health Stroke Scale, a tool that helps determine how severe a stroke is and which interventions may be most appropriate.

A retrospective study of children enrolled in a Northern California integrated health care system was conducted to evaluate their risk and outcomes after experiencing a symptomatic stroke.1 The analysis included data from inpatient and outpatient electronic records as well as radiology reports and clinical records. In addition, a multivariate logistic regression was used to assess the impact of different factors on critical care usage and outcome at discharge.

Overall, case fatality in the study was 4%, including six deaths directly attributable to stroke. The incidence of ischemic stroke was higher than that of hemorrhagic stroke, but the differences were not statistically significant. Hemorrhagic stroke was associated with an increased need for intensive care unit (ICU) admission, intubation and decompressive neurosurgery.

The Center for Cerebrovascular Disorders at Duke Children’s Health cares for children with a wide range of brain, spinal cord and nerve conditions. Our team includes experts in pediatric neurology, neurosurgery, hematology, emergency medicine, interventional radiology and vascular medicine. In addition to providing acute care in the emergency department, we provide ongoing rehabilitation and physical therapy, psychological and social services, and long-term follow-up for children who have suffered a stroke.