Signs and Symptoms

There are two main types of strokes:

• Ischemic Stroke -- With ischemic stroke, the blood supply to the brain becomes blocked. This prevents oxygen and nutrients from reaching brain cells. Within a few minutes, these cells begin to die.

• Hermorrhagic Stroke -- With hemorrhagic stroke, a blood vessel within the brain leaks or ruptures. This is called an intracerebral hemorrhage. When this happens, blood moving into brain tissue near the hemorrhage damages cells. In children, a malformation of the blood vessels in the brain, called an arteriovenous malformation, is a common cause of intracerebral hemorrhage. In a subarachnoid hemorrhage, blood leaks under the lining of the brain. This is often caused by a small bubble on an artery known as an aneurysm.

Each child may experience symptoms of stroke differently, depending on the area of their brain that has been affected. Similar to adults, the most common symptom of stroke is a weakness down one side of the body. However, it is important to note that this may be difficult to recognize in young children who may be too young to verbalize how they are feeling. A child's face may droop on one side and their speech may be affected. Other common symptoms of stroke in children may include:

• Sudden onset of difficulty with speaking, such as slurred or garbled speech
• Sudden onset of partial or complete blindness
• Sudden and severe headache
• Blurred or double vision or unequal pupils
• Drooling
• Brief loss of consciousness
• Seizures

Diagnosis

Early diagnosis of stroke is important for many reasons, including the prevention of a second stroke — which children are at higher risk of than adults — and starting a treatment program to help your child recover. If you think that your child has suffered from a stroke, you should contact their doctor immediately for a definite diagnosis.

In most cases, your child's pediatrician will then refer you to a neurologist, a board-certified medical doctor who specializes in the diagnosis and treatment of nervous system disorders, including diseases of the brain, spinal cord, nerves and muscles.

The neurologist will perform a thorough physical examination of you child to determine if he or she has had a stroke. If so, the doctor will locate the involved blood vessel, and determine the cause of the stroke. Your child's examination may include blood or urine tests, an electrocardiogram (ECG or EKG), an echocardiogram or imaging tests.

Imaging tests may include:

• Computed Tomography (CT) Scan -- With this test, X-ray beams are used to create a three-dimensional image of the brain.

• Magnetic Resonance Angiography (MRA) -- This procedure uses a strong magnetic field to show the arteries in the neck and brain.

• Magnetic Resonance Imaging (MRI) -- Using a strong magnetic field, a MRI can generate a three-dimensional image of the brain. A MRI is often used to locate an area of the brain that's been damaged by an ischemic stroke.

• Arteriography -- This shows arteries in the brain that can't be seen in regular X-rays and may be done if the tests listed above do not reveal the cause of the stroke. The doctor will make a small incision, usually in the patient's groin, then insert a catheter, which is a flexible, thin tube, carefully through the arteries and into the carotid or vertebral artery. The doctor will then inject a dye into the catheter that helps the patient's cranial arteries appear more clearly in an X-ray image.

Treatment

Your child's team of doctors will work together to determine the cause of your child's stroke, and then develop the most effective treatment plan to meet your child's individual needs. Recovery differs for each child, depending on the area of their brain that was affected, as well as the cause of the stroke and whether or not they have any underlying medical conditions.

There are many therapies available to help prevent a recurrent stroke in your child. Medications, such as aspirin, heparin or warfarin, may be used to thin the blood and make it less likely to clot.

In addition, different types of therapy including occupational therapy, physical therapy, speech and language therapy also are available and play an important part in your child's recovery. These therapies typically begin as soon as possible after stroke. Therapy is usually most intense in the early stages following stroke. A therapist may offer ideas for hands-on therapy to your family and child's school, which help your child participate fully in play and other activities. Equipment, such as ankle or hand splints, may be used to help your child move more easily and reduce the risk of permanent joint stiffness.