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Signs & Symptoms

Program: Diagnosing and Treating Pediatric Stroke
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Andrew Schorr:

Now what about recognizing the signs of this? So you have children and sometimes even teenagers where this shows up. Would there be any earlier indications that someone could be looking for that where otherwise it might be missed?

Dr. Fullerton:

In the older children, the symptoms of a stroke are fairly similar to what we see in adults. The most common symptom is weakness on one side of the body, and so parents might notice that the child's face suddenly appears to be droopy on one side and that their smile is asymmetric, and then they'll also notice that the child has difficulty using the hand on one side and that they may be dragging the foot on that same side, and so if a child ever has sudden onset weakness on one side of the body, that certainly is a warning sign for a possible stroke, and that should be evaluated emergently. That child should be taken by ambulance to an emergency room to be evaluated.

Babies, when babies have strokes, they can present very, very differently. They often won't actually develop weakness on one side of the body at the time of the stroke. The only symptoms that they may have will be excessive sleepiness, and then they also may develop a seizure in the first few days of life. Some babies with stroke though won't develop any of those signs and symptoms at the time of birth, and then the only sign that they have of stroke is when later in infancy when they're maybe six or eight months of age, the parents or the pediatrician will notice that the child has a hand preference, that they prefer to use one hand to reach for things and that they won't use the other hand to reach, and that actually can be the first sign that a baby actually had a stroke around the time of birth.

Andrew Schorr:

Now, with the treatments that you can bring to bear, and I know it varies greatly by the individual situation, what is the prospect of a child going on and having a normal life?

Dr. Fullerton:

So again it depends on the cause of the stroke, also the location of the stroke, and the age at which the child has the stroke. When babies have strokes, they have remarkably good outcomes. About a third of those babies though will go on to have some sort of significant motor deficit meaning that they will have difficulty using one hand, and then we're also recognizing that many of these children will go on to have some difficulties in school, and that can often actually be under recognized, but for the most part these children can go on to lead very healthy and productive lives. They use their good hand and learn how to do things with their good hand, and if they are recognized by their schools to have a problem, often they can get special education from the school, special sort of interventions by the school to allow them to really thrive and learn in school, so it's very important that the strokes are recognized, that the teachers are aware of the stroke, and that the school makes an attempt to basically create a specialized plan for that child's education.

In the older children the same things applies. They can basically have difficulties with their motor strength, and they can be left with a disability. They can also have problems in school. And then the other thing that we worry more about in those children is also their risk of having a recurrent stroke, and certainly if you have a recurrent stroke, then you have additional brain injury, and the more injury that a child has to the brain over time certainly the worse they're going to do in the long run, and that's why it's just so important that children who have stroke be well evaluated to determine their risk of having a recurrence, and if there is a high risk of recurrence that they explore all treatment options that can potentially lower that risk.

Andrew Schorr:

I would imagine with the specialization of your center people come from far and wide, and you're very used to that at UCSF.

Dr. Fullerton:

That's right. We do see children who come from far away, and unfortunately there are also children who would like to come here from far away and don't have the resources, but we do see children from all over.

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