Cerebrovascular disorders are among the top ten causes of death of children in the United States. Stroke in childhood affects at least one in 4,000 newborns and approximately 2,000 older children each year. When a stroke occurs, significant long-term impairment to intellectual and neurological function is possible. Stroke can also be life threatening if not treated promptly.
Strokes can be categorized as ischemic (not enough blood flow) and hemorrhagic (bleeding into the brain). Treatment options and long-term outcome in pediatric patients vary depending on the cause of stroke.
Stroke Symptoms include:
- Weakness on one side of the body (hemiparesis)
- Slurred speech
- Sudden lethargy and drowsiness
- Seizure affecting only one side of the body
- Early hand preference (before 12 months of age) in infants
Additional symptoms related to brain tissue dysfunction caused by a stroke may be seen. These symptoms depend on the location of the stroke. For example, if a stroke occurs in the cerebellum at the back of the head, a child may have trouble walking or experience balance and coordination problems. If the tumor affects the back of the brain (occipital lobes) or the optic pathway, which is responsible for sight, they may experience vision changes.
If a child experiences the symptoms above, a rapid and thorough evaluation by a pediatrician or neurologist is needed to diagnose the problem. This evaluation usually includes imaging of the brain via magnetic resonance imaging (MRI). If the MRI shows a stroke, the search for a cause begins as the reason for a stroke has a significant impact on the treatment plan. Tests may include ultrasound of the heart (echocardiogram), blood work for blood clotting disorders, and a number of other studies. Depending on the cause of the stroke, additional specialists may be asked to get involved in developing the treatment plan. For example, if the stroke is thought to be related to a blood clot, a hematologist may join the team.
The Johns Hopkins difference is seen in our approach of involving multiple specialties to review the cases of children with strokes. Neurologists, neuroradiologists, neurosurgeons, neuro-ophthalmologists, pediatric cardiologists and hematologists, among others, may join together to evaluate and develop a treatment plan for a child with a stroke or arteriovenous malformation. The team will decide whether observation, medical management, or surgery (in select cases) is the best option, or if a combination of these approaches will be more effective.
Medical Therapy – may include aspirin, blood thinners called anti-coagulants, or special vitamins. For patients with sickle cell anemia and stroke, medical therapy may also include transfusion therapy or hydroxyurea. Other treatment options are very specific to the individual child. For example, a child who has seizures because of a stroke might need anti-seizure medication.
Surgery – the purpose of neurological surgery in stroke is generally to increase blood flow to the brain for patients with abnormal blood vessels which feed the brain. There is not a surgical procedure to “cure” a stroke, but rather surgery may prevent new strokes in certain patients.
Interventional Neuroradiology – in patients with abnormal blood vessels which feed the brain (arteriovenous malformations) or aneurysms, sometimes a catheter can be placed inside the blood vessel to allow non-surgical treatment of the problem.
The Johns Hopkins difference can be seen by our depth of expertise in pediatric cerebrovascular disease, and by our partnership with the Kennedy Krieger Institute, world renown in pediatric neurorehabilitation. Follow-up care is extremely important in tracking the progress of a child’s recovery.