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Introduction

Program: Diagnosing and Treating Pediatric Stroke

Table of Contents

  1. Introduction
  2. Difficulties Diagnosing Childhood Stroke
  3. Treatment Options
  4. Signs & Symptoms
  5. Screening High Risk Children

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Andrew Schorr:

Hello and welcome to our Patient Power program sponsored by UCSF Medical Center. I'm Andrew Schorr. In this program we're discussing stroke in children; diagnosing and treating rare but potentially lethal pediatric stroke, and with us is a true expert in that, that's Dr. Heather Fullerton. Dr. Fullerton is Director of the UCSF Pediatric Stroke and Cerebrovascular Disease Center.

Dr. Fullerton, when we think about stroke in children, I don't know that I've ever heard about it myself, it must be very rare. How often does it occur?

Dr. Fullerton:

It's actually more common than you would think. We see it in about 1 per 4,000 live births, so meaning 1 per 4,000 babies that are born will actually be born with a stroke, and then we see it less commonly in older children, but it happens in about 4 per 100,000 children every year, and so it ends up being about 4,000 children in the U.S. who will end up having a stroke every year.

Andrew Schorr:

Whoa, well that's scary certainly. So what is happening, and I know there are a variety of causes. Help us understand typically what must be going on, and does it happen right at birth right when the child may still be in the hospital, or how does this roll out, if you will?

Dr. Fullerton:

So we generally do divide pediatric stroke into two very different categories; the neonatal strokes and the childhood strokes. The neonatal strokes are common but relatively poorly understood. We think that they do happen right around the time of birth and probably related to multiple different factors that are coming together at the time of birth to cause a blood clot to go to the brain and result in a stroke, and part of that is actually physiologic in that a mother forms blood clots more easily around the time of birth. This is something she has to do so that when she delivers the placenta she basically can clot off and not bleed after delivering the placenta, but other things are probably happening as well around the time of birth that lead to a stroke, and it may be things related to inflammation of the placenta, like an infection in the placenta, or a blood clotting disorder in either the mother or the baby, but this actually is not very well understood. Fortunately though, those babies tend to do relatively well and are very unlikely to have any recurrent strokes.

Childhood stroke is a very different story. We do understand it somewhat better, and we know that the etiologies are very different from strokes that we see in adults, and there are multiple etiologies in children, and we also know that children are at higher risk of suffering recurrent stroke, which is why it is important for us to evaluate children thoroughly so that we can figure out the best way of preventing recurrent strokes in them, but in children we find that congenital heart disease is a cause of stroke. Also children with sickle cell disease are at quite high risk of stroke, and then many other children who were just previously healthy and present with a first-time stroke actually have some sort of abnormalities of the blood vessels that lead to the brain, and the abnormalities were still trying to better understand. We know that some children will actually develop tears in the blood vessels that go to the brain. Other children will develop blood vessel narrowing that seems to be related to infections such as chicken pox infection, and other children will just spontaneously develop narrowing of the blood vessels to the brain that we actually don't understand; we don't know why it happens, but it is something that can cause stroke and actually also can put those children at high risk of having a recurrent stroke.

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