Brain, Nervous System and Mental Conditions

Stroke

What is stroke?

Stroke happens when blood that carries oxygen and nutrients stops flowing to part of the brain. Without a steady supply of blood, brain cells in the area begin to die within minutes. This can lead to stroke symptoms and sometimes to lasting neurologic deficits or death.

Many people have heard of stroke in adults, but stroke can happen at any age – in newborns, children, teens – and even before birth. Perinatal strokes and childhood strokes are often different from adult strokes, with different causes and sometimes different symptoms and treatments.

A stroke is a medical emergency. If you think a child is having a stroke, call 911. Quick diagnosis and treatment may help limit damage to the brain.

Stroke at Seattle Children’s

Seattle Children’s is the only hospital in the Pacific Northwest with a well-developed program to treat pediatric stroke. Our Neurology program is ranked #9 in the country by U.S. News & World Report.

We treat patients from the Washington, Alaska, Montana and Idaho region, as well as Hawaii and Oregon, and our experts provide consultation to doctors around the country.

Leader in pediatric stroke

Dr. Catherine Amlie-Lefond directs the Pediatric Vascular Neurology Program, which provides stroke care. She is a pediatric vascular neurologist who is a national leader in treatment of stroke in children.

Amlie-Lefond serves on the medical advisory board of the International Alliance for Pediatric Stroke. She chairs the mentoring committee for development of pediatric stroke programs for the International Pediatric Stroke Study (IPSS). She also serves on the IPSS publications committee. Amlie-Lefond is chair of pediatric stroke for the American Heart Association/American Stroke Association International Stroke Conference program committee.

Team approach to treatment

The Pediatric Vascular Neurology Program brings together specialists from many areas of Seattle Children’s to treat stroke as a team. This is important because stroke treatment can be complex. Your child gets the combined knowledge and skills of doctors, surgeons, nurses and therapists from Neurology, Neurosurgery, Radiology, Hematology, Cardiology, Rehabilitation Medicine, Emergency Department, Critical Care Medicine and other fields.

Quick access

Our Emergency Department provides immediate care, 24 hours a day, 7 days a week, for babies, children and adolescents having a stroke.

Amlie-Lefond and others on the stroke team are available to see patients quickly in the hospital or clinic, to perform urgent surgery or to consult with doctors at other hospitals to stabilize young stroke patients and transfer them to Seattle Children’s as soon as possible.

We also make access easy for you in nonemergency situations – for example, if your child is referred for a clinic visit because:

  • They have symptoms that suggest they might have had a stroke sometime in the past
  • They need follow-up care after a stroke
  • They have a condition that increases the risk for stroke

Precise diagnosis by experts

In babies and children, epilepsy, tumors, migraine headache and many other conditions can mimic stroke. Careful, expert diagnosis is essential to tell pediatric stroke from other health problems so your child gets the right treatment.

Our experienced pediatric neurologists and neuroradiologists work together closely to choose the imaging studies your child needs, such as an MRI (magnetic resonance imaging) scan, and to review the images to understand your child’s exact condition. We offer MRI with sedation by anesthesiologists who specialize in pediatrics so your child is calm and comfortable.

High-quality, comprehensive care

Our focus is on giving your child the right care at the right time, from diagnosis to rehabilitation and long-term follow-up, so your child has the best possible recovery.

Seattle Children’s already meets the standards for patient care proposed by national experts to qualify hospitals as primary pediatric stroke centers or pediatric stroke centers of excellence in the future.

  • Pediatric stroke team available 24 hours a day, 7 days a week: Our experts are here when you need them.
  • Emergency medical care: The Emergency Department offers round-the-clock access to Seattle Children’s specialists and the full facilities of our hospital.
  • Pediatric stroke order sets for the Emergency Department and intensive care unit (ICU): These help ensure we deliver the right care to your child at the right time.
  • Neurosurgical services: Our neurosurgeons have some of the best outcomes in the nation for revascularization surgery.
  • Pediatric ICU: We also have a Level IV neonatal ICU, the first in the state.

Research to improve stroke prevention and treatment

Seattle Children’s takes part in the International Pediatric Stroke Study to look for patterns among children who have had a stroke. We also work with other researchers to study seizures in babies after perinatal ischemic stroke. 

Studies like these, that involve researchers from around the world, are important for learning why strokes happen and how we can best prevent and treat them. Read more.

Types of Stroke

There are 2 main types of stroke:

  • A blood vessel in the brain is blocked. This is ischemic stroke (pronounced iss-KEE-mik). Blood cannot get through the vessel to deliver oxygen and nutrients to the cells that need it.
  • A blood vessel in the brain is bleeding. This is hemorrhagic stroke (pronounced hem-or-ADJ-ik). Blood is leaking from the vessel before it can get to the cells that need oxygen and nutrients.

Ischemic stroke

In ischemic stroke, the blood vessel may be blocked by a blood clot that formed in the blood vessel (thrombus) or a clot that formed somewhere else in the body, such as the heart, and then traveled to the brain through the bloodstream (embolism).

Doctors group pediatric ischemic strokes by the age of the child.

  • Perinatal ischemic stroke (PIS): Stroke before birth or in a newborn (age 28 days or younger)
  • Presumed perinatal ischemic stroke (PPIS): Stroke symptoms start after age 28 days and tests suggest the baby had a stroke on or before age 28 days
  • Childhood arterial ischemic stroke (childhood AIS or CAIS): Stroke at age 29 days or older

Hemorrhagic stroke

Causes of hemorrhagic stroke include:

  • Weak blood vessel bursting
  • Trauma, such as a head injury, that tears the wall of a blood vessel
  • Blood that does not clot as well as it should

In hemorrhagic stroke, the lack of oxygen-rich, nutrient-rich blood to brain cells is only one problem. Another problem is that blood builds up where it does not belong — in the brain but outside a blood vessel. This blood can put pressure on the brain, form clots or cause nearby blood vessels to close up (vasospasm), which can also damage the brain.

Stroke in Children

Overall, about 1 in 20,000 children has a stroke. The rate is highest in newborns: about 1 in 2,500.

Stroke risk factors

Many of the main risk factors for children are different than in adults. (In adults, the main risk factors are atherosclerosis, high blood pressure, diabetes, high cholesterol and smoking.)

Doctors and researchers are working to understand factors that increase the risk for stroke before birth or in newborns. So far studies have not found any clear, strong links.

Some health conditions or medicines may increase a child’s risk for stroke after the perinatal period. Risk factors include:

  • Abnormal blood vessels in the brain, such as moyamoya, arteriovenous malformation, cerebral cavernous malformation, PHACE syndrome with vascular anomalies, aneurysm and vasculitis
  • Heart problems, including congenital heart disease
  • Infection, such as chickenpox or meningitis
  • Trauma, mainly if a blood vessel in the head or neck is injured
  • Sickle cell disease or other blood conditions that cause abnormal clotting (thrombosis) or bleeding
  • Cancer and chemotherapy
  • Inflammatory or autoimmune diseases, such as systemic lupus erythematosus and juvenile rheumatoid arthritis
  • Dehydration
  • Birth control pills (oral contraceptives)

Related conditions: CVST and TIA

Cerebral venous sinus thrombosis (CVST) is a blood clot that blocks a vein or channel (venous sinus) that drains blood from the brain.

This blood has already delivered oxygen and nutrients to brain cells. It is flowing back to the heart. Even so, CVST can cause a stroke if blood backs up behind the clot. The backup can slow or stop blood flow in the brain’s arteries. The backup can also lead to bleeding in the brain.

Another name for CVST is cerebral sinovenous thrombosis (CSVT).

Transient ischemia in the brain is a short-term blockage in blood flow that clears up on its own. The symptoms are the same as for stroke, but they last no more than a day, usually no more than 15 minutes. It can be a warning sign before a full stroke.

Transient ischemia is sometimes called:

  • Transient ischemic attack (TIA)
  • Transient ischemic event
  • Mini-stroke

In childhood, transient ischemia can be linked with abnormal arteries in the brain.

Contact Us

A stroke is a medial emergency. If you think a child is having a stroke, call 911.

For non-emergencies: To make an appointment with a Seattle Children’s provider, you need a referral from your child’s primary care provider or another specialist. If you have a referral, call 206-987-2078.