Brain, Nervous System and Mental Conditions

Stroke

What is stroke?

Stroke happens when blood stops flowing to part of the brain. Blood carries oxygen and nutrients. Without a steady supply of blood, brain cells in the area begin to die within minutes.

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 their brain.

Stroke can happen at any age – in newborns, children and teens – and even before birth. Stroke that happens while a baby is developing during pregnancy or within 1 month after birth is called perinatal. Perinatal strokes and childhood strokes are often different from adult strokes, with different causes and sometimes different symptoms and treatments.

  • There are 2 main types of stroke:

    • Ischemic (iss-KEE-mik)
    • Hemorrhagic (hem-or-ADJ-ik)

    Ischemic stroke

    In ischemic stroke, a blood vessel in the brain may be blocked by a blood clot. The clot may form:

    • In a blood vessel. This is called a thrombus.
    • Somewhere else in the body, such as the heart, and then travel to the brain through the bloodstream. This is called an embolism.

    Hemorrhagic stroke

    In hemorrhagic stroke, blood leaks from a vessel and does not reach the cells that need it. This may happen because:

    • A weak blood vessel leaks or bursts (aneurysm or arteriovenous malformation)
    • Trauma, like a head injury, hurts a blood vessel
    • Blood does not clot as well as it should

    In hemorrhagic stroke, blood also may build up and put pressure on the brain, form clots or cause nearby blood vessels to close up (vasospasm).

  • Transient ischemic attack (TIA)

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

    Transient ischemia (iss-KEE-mee-uh) is sometimes called:

    • Transient ischemic event
    • Mini-stroke

    In childhood, TIA may be related to abnormal arteries in the brain.

    Cerebral venous sinus thrombosis (CVST)

    A CVST is a blood clot that blocks a vein or channel (venous sinus) that drains blood from the brain. CVST can cause a stroke if blood backs up behind the clot. The backup can also lead to bleeding in the brain.

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

  • The main risk facthrombosistors for stroke in babies and children are different from those in adults. Doctors and researchers are working to understand what increases the risk of stroke before birth and in newborns.

    In children and babies older than 1 month, these health conditions and medicines may increase the risk for stroke:

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. Experts at our Pediatric Vascular Neurology Program will care for your child.

  • If you think your child is having a stroke: Call 911. Stroke is a medical emergency.
  • For nonemergencies: Ask your child’s primary care provider or specialist for a referral. If you have a referral, call 206-987-2016 to make an appointment.

  • Dr. Catherine Amlie-Lefond is a national leader in treatment of stroke in children. She is a pediatric vascular neurologist and directs our Pediatric Vascular Neurology Program.

    Dr. Amlie-Lefond:

    • Has cared for many hundreds of newborns and children with stroke
    • Does research to prevent strokes and improve care of children who have them
    • Serves on the medical advisory board of the International Alliance for Pediatric Stroke
    • Holds leadership positions with the International Pediatric Stroke Study (IPSS)

  • The Pediatric Vascular Neurology Program is part of our Neurosciences Center, which is ranked #1 in the Northwest by U.S. News & World Report. Our experts provide consultation to doctors around the country. 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): The right care to your child at the right time.
    • Neurosurgery: 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.

  • The Pediatric Vascular Neurology Program brings together specialists from many areas of Seattle Children’s to treat stroke as a team. Your child gets the combined knowledge and skills of doctors, surgeons, pharmacists, nurses and therapists. This is important because stroke treatment can be complex.

    We stay in close communication with you – and with your child’s other providers – from diagnosis and treatment through rehabilitation and follow-up.

    The team coordinates care so your child gets treated for related conditions they may have. These include heart defects or blood disorders that increase the risk of blood clots or bleeding.

    Your child may see experts in:

    • Our Emergency Department provides immediate care, 24 hours a day, 7 days a week, for babies, children and adolescents having a stroke.
    • Dr. Amlie-Lefond and others on the stroke team are available to see patients quickly in the hospital or clinic.
    • Seattle Children’s is the only hospital in the region with round-the-clock, on-site coverage by a pediatric neurosurgeon.
    • Team members are available to consult with doctors at other hospitals to stabilize stroke patients and transfer them to Seattle Children’s as soon as possible. We treat patients from Washington, Alaska, Montana, Idaho, Hawaii and Oregon.
    • We also see many children in our clinic for nonemergencies. Some have symptoms that suggest a previous stroke. Others need follow-up care after a stroke. We also treat children who have a condition that increases their risk for stroke.

    • Our team has the experience to tell pediatric stroke from other health problems to make sure your child gets the right treatment. In babies and children, many other conditions – like brain tumors or migraine headaches – can look like a stroke.
    • Our pediatric neurologists and neuroradiologists work together to choose the tests (imaging studies) needed to understand your child’s exact condition. We offer MRI (magnetic resonance imaging) with sedation by anesthesiologists who specialize in caring for babies, kids and teens so your child is calm and comfortable.
    • We offer the treatments that fit your child’s needs. Options include medicines, surgery, treatment for underlying conditions and rehabilitation so your child has the best possible recovery.

    • Seattle Children’s takes part in the International Pediatric Stroke Study to look for patterns in children who have had a stroke. Combining medical information about hundreds of children who have had a stroke may lead to better prevention, diagnosis and treatment.
    • We also work with other researchers to study seizures in babies after perinatal ischemic stroke. This groundwork will lead to research studies on ways to prevent and treat severe epilepsy in these children.
    • Our patients have the option to take part in clinical trials of promising new treatments. These can be especially important if your child’s condition is not well controlled with standard medicines or surgeries.

    Learn about Seattle Children’s brain research.

    • Children don’t react to illness, injury, pain and medicine in the same way as adults. They need – and deserve – care designed just for them. They need a healthcare team specially trained to understand and meet their needs.
    • Our doctors have special training to diagnose and treat children. They are focused on how today’s treatment will affect your child as they develop and become adults.
    • Our experts base their treatment plans on years of experience and the newest research on what works best – and most safely – for children and teens.
    • As your child grows, we meet their changing needs, whether they are a youngster going back to school after brain surgery or a teen taking more responsibility for their health.

Symptoms of Stroke

Symptoms of stroke tend to be different in newborns than in older children.

  • Seizures are a common symptom of strokes that happen while a baby is developing during pregnancy or within 1 month after birth (perinatal). Usually, seizures start 12 to 48 hours after birth and repeat. Most newborns with stroke have general symptoms that can also be caused by other conditions. These include:

    • Low muscle tone and strength, making the baby seem floppier than normal
    • Being sleepier than normal (lethargy)
    • Pauses in breathing (apnea)
    Some babies have no clear symptoms for weeks or months after their stroke. Often parents, caregivers and doctors do not notice any signs of perinatal stroke until age 4 to 6 months.

    At that time, a baby may have seizures, show developmental delays or start to seem weaker or partly paralyzed on 1 side of the body. This is called hemiplegia or hemiparesis. You may notice your baby:

    • Moving 1 side of their body less well than the other.
    • Keeping fingers and toes on 1 side of their body clenched in a fist.
    • Using 1 hand much more than the other. This is not common before age 1 in healthy babies.

  • Children who have a stroke after their first month of life tend to have symptoms that come on suddenly. Your child may have 1 or more of these:

    • Weakness, paralysis or numbness in the face, arm or leg. Usually this only affects 1 side of their body.
    • Trouble speaking, understanding language, reading or writing (aphasia).
    • Changes in vision, such as decreased vision or double vision.
    • Dizziness, loss of balance or loss of ability to stand or walk.
    • Sudden, severe headache.
    • Seizures in a child who has not had seizures before. Usually seizures involve only 1 side of the body, followed by weakness on that side.

Diagnosing Stroke

To diagnose stroke, your doctor will:

  • Examine your child
  • Ask about their symptoms and health history
  • Order tests (imaging studies) of your child’s brain

Your child’s doctor will use the test results to find the cause of the stroke and plan the best treatment.

  • Your doctor may want pictures of your child’s brain to look for blockage, bleeding or problems with the blood vessels. Your child may have 1 or more of these imaging studies:

    • CT (computed tomography) scan
    • MRI (magnetic resonance imaging) scan
    • MRA (magnetic resonance angiography)
    • Ultrasound
    • Cerebral angiogram

  • Your child may also need 1 or more of these tests:

    • Blood tests to check for clotting or bleeding problems, infection or diseases that might increase stroke risk
    • Echocardiogram to check for heart problems
    • Electrocardiogram to check for problems with heart rate or rhythm
    • Electroencephalogram to look for the cause of seizures

Treating Stroke

Your child will receive care from our Pediatric Vascular Neurology team.

  • Your child’s care may start in our Emergency Department during or immediately after having a stroke.
  • Some children come to us after emergency care at another hospital.
  • After urgent treatment, many children need to stay in the hospital, possibly in our Pediatric Intensive Care Unit (PICU) or Level IV Neonatal ICU (NICU).
  • Some children are referred for a clinic visit by their primary care provider or another specialist.

Treatment Options

Our main goals are to:

  • Stop further damage from the stroke
  • Help your child recover as fully as possible
  • Prevent future strokes or related health problems
  • Support your child and family through this challenge

Your child’s treatment and their care team will depend on:

  • The type of stroke
  • How the stroke has affected your child
  • Any underlying condition that caused the stroke

  • If a blood clot is blocking blood flow in your child’s brain (ischemic stroke), doctors may use blood thinners (antithrombotics, antiplatelets or anticoagulants) to keep clots from getting larger and to prevent new clots.

    To prevent or reduce symptoms or side effects of treatment, your child may get medicines to:

    • Control seizures
    • Prevent or treat fever
    • Reduce swelling in the brain

    These measures may help protect brain cells that are damaged but still alive.

  • Your child may need surgery to:

    • Open their skull to reduce pressure on their brain caused by bleeding or swelling
    • Drain extra blood that leaked from the blood vessels and built up in their brain
    • Drain extra cerebrospinal fluid (CSF) around the brain through a small tube (shunt)

  • If your child has an underlying condition that might have caused the stroke – and might cause future strokes or other health problems – doctors will recommend treatment for this condition. Treatment may include:

  • After your child receives any urgent or emergency treatment they need for stroke, the team at Seattle Children’s plans and provides ongoing care so your child has the best possible outcome. We evaluate all your child’s health needs and work with you to create a care plan that fits your child and family.

    Many children have some lasting effects of their stroke (neurologic deficits). The effects depend on the part of the brain that was damaged.

    To prevent or reduce lasting effects, your child may benefit from:

    If your child has problems with learning, emotions or behavior, they may see experts in:

    Our stroke team is experienced in helping children return to school and other important activities after stroke. We also work with you to find resources in your community.

  • About 10% of children who have a stroke will have another stroke in the future. The risk for each child depends on many factors, including the cause of the stroke. Your child’s team will take steps to prevent future strokes.

    We will teach you – and your child, when they are old enough – how to lessen the risk. Steps include:

    • Drinking water and other fluids each day to keep your child’s blood volume and blood pressure high enough for good blood flow.
    • Using medicines that prevent blood clots from forming.
    • Avoiding medicines that constrict the blood vessels, unless recommended by a doctor who knows about stroke and your child’s health history. These include medicines for migraine headaches.
    • Using caution with medicines that increase the risk of blood clots, such as birth control pills.
    • Getting exercise each day.
    • Eating a healthy diet, high in vegetables and fruits and low in salt.

    • Stroke touches the whole family. You are not alone. We will help you cope with the effects of your child’s stroke.
    • During visits, we take time to explain your child’s condition. We help you fully understand your treatment options and make the choices that are right for your family.
    • Our doctors, nurses, child life specialists and social workers help your child and your family through the challenges of their condition.
    • At Seattle Children’s, we work with many children and families from around the Northwest and beyond. Whether you live nearby or far away, we can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.

    We connect you to community resources and support groups, such as:

  • When your child is older and ready to transition to adult care, we work closely with the UW Medicine Stroke Center at Harborview Medical Center as needed. This helps ensure your child keeps getting comprehensive, customized care.

    Many of the doctors who treat stroke at Seattle Children’s also treat stroke in adults at Harborview.

Contact Us

Stroke is a medical emergency. If you think your child is having a stroke, call 911.

For nonemergencies:

  • If you would like an appointment, ask your child’s primary care provider for a referral.
  • If you have a referral, call 206-987-2016.
  • Providers, see how to refer a patient.
  • If you have any questions, please contact us at 206-987-2016 or 844-935-3467 (toll-free).