Recognize the signs and symptoms of pediatric stroke

Treatment during the first hours and days after a stroke is critical in optimizing outcomes, according to Arpita Lakhotia, M.D., pediatric neurologist with Norton Children’s Neuroscience Institute, affiliated with the UofL School of Medicine.

Stroke is the sixth-leading cause of death in children, and early recognition is key. Those at higher risk of stroke include newborns and pediatric patients with sickle cell anemia, congenital heart defects, immune disorders, clotting disorders and hidden disorders, such as narrow blood vessels.

If a pediatric stroke is suspected, Norton Children’s has implemented an alert system known as a brain attack (BAT) pathway alert. This involves multidisciplinary support to help catch a pediatric stroke early and provide prompt treatment. A BAT alert involves multiple specialties including emergency department, pediatric neurology neurovascular specialists, ICU, radiology specialists, pediatric anesthesia and nurse managers.

“Early recognition is the most important aspect,” said Arpita Lakhotia, M.D., pediatric neurologist with Norton Children’s Neuroscience Institute, affiliated with the UofL School of Medicine. “Early recognition and appropriate management during the first hours and days after a stroke is critical in optimizing long-term function and outcomes and in minimizing recurrence risk.”

Following the BAT protocol also encourages hyperacute treatments, such as endovascular intervention (due to the collaboration with endovascular specialists) and intravenous tissue plasminogen activator (IV tPA).

Stroke in children usually begins suddenly. Common symptoms may include weakness or numbness of the face, arm or leg, usually on one side of the body; slurred speech or difficulty with language; trouble balancing or walking; vision issues, such as double vision or loss of vision; and sudden lethargy or drowsiness. A sudden, extremely painful headache associated with vomiting and sleepiness is also an indicator of stroke. Symptoms may vary by age.

Symptoms of stroke in children and teens

  • Weakness or numbness of the face or leg (usually one side of the body)
  • Loss of coordination
    • Trouble walking
    • Trouble moving one side of body
  • Speaking issues
    • Difficulty understanding language or simple directions
    • Slurred speech
  • Severe headache (with vomiting or sleepiness)
  • Vision disruptions in one or both eyes
  • Dizziness
  • New appearance of seizures
  • Drowsiness
  • Progressively worsening nonstop headache
    • Sudden onset of “worst headache of my life”
  • Repetitive vomiting

Symptoms of stroke in newborns and infants

  • Seizures
  • Paralysis
  • Extreme sleepiness (not wanting to wake to feed)
  • Tendency to use only one side of body

Perinatal arterial strokes are much more common (about 1 in 4,000 live births) than childhood strokes, and this is due to several risk factors, said Dr. Lakhotia.

Signs of stroke in newborns can be harder to detect, as symptoms may not appear until 4 to 6 months of age. If a child’s stroke led to any weakness, it may not be noticeable until the age of certain developmental milestones, such as crawling, sitting upright or turning over.

A network of cutting-edge research

Norton Children’s Neuroscience Institute’s research unit partners with the International Pediatric Stroke Organization (IPSO) and the International Pediatric Stroke Study (IPSS), the world’s largest and most successful childhood stroke registry and network made up of dedicated clinicians, scientists and research staff from over 100 institutions in 34 countries.


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