Stroke

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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 strokes and childhood strokes are often different from adult strokes, with different causes and sometimes different symptoms and treatments.

Vascular Neurology at Seattle Children's

Seattle Children’s Pediatric Vascular Neurology Program provides world-class, comprehensive care for babies, children and adolescents with stroke and other conditions that affect the brain’s blood flow.

There are 2 main types of stroke:

  • Ischemic (ih-SKEE-mik), when a blood clot blocks a blood vessel in the brain. A clot that forms in a blood vessel in the brain is called a thrombus. A clot that forms somewhere else and travels to the brain is called an embolism.
  • Hemorrhagic (heh-meh-RA-jik), when blood leaks from a vessel and does not reach the cells that need it. This can happen because of injury or if a weak blood vessel leaks or bursts ( or ).

A boy climbs a tree

“We felt so blessed going to a hospital that had a specialty in pediatric stroke — something that, until that day, I did not even know could happen to kids.”

Laurie Donati, mother of Dominic, treated at Seattle Children’s after strokes at age 9

Two related conditions also cause problems with blood flow in the brain:

  • Transient ischemic attack (TIA) is a short-term blockage in blood flow that clears up on its own. The symptoms are the same as for stroke, but last no more than a day, usually no more than 15 minutes. TIA can be a warning sign before a full stroke and is sometimes called a mini-stroke.
  • Cerebral sinovenous thrombosis (CSVT) is a blood clot that blocks a vein or channel (venous sinus) that drains blood from the brain. If blood backs up behind the clot, CSVT can cause a stroke or bleeding in the brain. Another name for CSVT is cerebral venous sinus thrombosis (CVST).

A girl stands in a field“We learned that we were not alone, that we were not the only family dealing with this. That was the most healing part of our journey. We found a whole group of parents, siblings and other survivors that understood the challenges and lifted us up when we needed it most.”

Makenzie’s mom, Jamie, Spanaway, WA

Symptoms of Pediatric Stroke

Symptoms of stroke tend to be different in newborns than in older children. Strokes that happen while a fetus is developing during pregnancy or within 1 month after birth are called .

  • Symptoms of newborn or fetal stroke

     are a common symptom of perinatal stroke. 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  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.
    • Using 1 hand much more than the other. This is not common before age 1 in babies without stroke.
  • Childhood stroke symptoms

    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 Pediatric Stroke

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

To diagnose stroke, experts in our Pediatric Vascular Neurology Program will:

  • Examine your child
  • Ask about their symptoms and health history
  • Make of your child’s brain
  • Do other tests as needed to find conditions that increase stroke risk

Your child’s doctor will use the test results to plan the best treatment.

  • Imaging studies of the brain

    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:

    • scans of the arteries
    • to map blood vessels in your child’s brain
  • Other tests

    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
    • (echo) to check for heart problems
    • (ECG) to check for problems with heart rate or rhythm
    • (EEG) to look for the cause of seizures

Risk factors for pediatric stroke 

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

Treating Pediatric Stroke

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

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

Stroke Treatment Options

  • Medicines

    If a blood clot is blocking blood flow in your child’s brain (ischemic stroke), doctors may use blood thinners (,  or ) 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
    • Prevent or treat fever
    • Reduce swelling in the brain

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

  • Surgery

    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 around the brain through a small tube ()
  • Treatment for underlying causes

    In some children, an underlying condition caused the stroke — and might cause future strokes or other health problems. Your child may need treatment such as:

Rehabilitation and Follow-Up Care

After your child receives any urgent or emergency treatment they need for stroke, our Pediatric Vascular Neurology team partners with Rehabilitation Medicine, 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 (). 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.

  • Preventing future strokes

    About 10% of children who have a stroke will have a stroke again 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:

    • Use medicines that prevent blood clots from forming.
    • Avoid 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.
    • Drink water and other fluids each day to keep blood volume and blood pressure high enough for good blood flow.
    • Use caution with medicines that increase the risk of blood clots, such as birth control pills.
    • Get exercise each day.
    • Eat a healthy diet, high in vegetables and fruits and low in salt.
  • Support for your whole family
    • 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, and help your child and your family through the challenges of their condition.
    • At Seattle Children’s, we work with 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:

  • Transition to adult care

    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 complete, custom care.

Why choose Seattle Children’s for your child’s stroke care?

Experts in our Pediatric Vascular Neurology Program work as a team to care for your child from diagnosis and treatment to rehabilitation and long-term follow-up. We also provide second opinions. Seattle Children’s provides stroke treatment and preventive care to children throughout the Pacific Northwest.

The Pediatric Vascular Neurology Program director, Dr. Catherine Amlie-Lefond, is an international expert in pediatric stroke. She has cared for hundreds of newborns and children with stroke. She conducts research and serves on the medical advisory board of the International Alliance for Pediatric Stroke.

Seattle Children’s meets the standards for patient care proposed by national experts to qualify hospitals as primary pediatric stroke centers or pediatric stroke centers of excellence.

  • Expert care for pediatric stroke available 24 hours a day, 7 days a week.
  • Pediatric stroke  and guidelines, so your child gets the right care at the right time, in the Emergency Department (ED) and Intensive Care Unit (ICU).
  • Emergency Department for round-the-clock immediate care and access to Seattle Children’s specialists and the full facilities of our hospital.
  • Neurosurgeons with some of the best outcomes in the nation for .
  • Neurocritical Care team to protect your child’s brain, prevent new issues and help your child heal.
  • Pediatric Intensive Care Unit (ICU) and Level IV Neonatal ICU.

“There’s no such thing as a minor stroke. It is a huge event when it happens, and it can rock a family’s world. The families and children I work with are so special, because they always manage to rise to the challenge.”

Dr. Catherine Amlie-Lefond, Director, Seattle Children’s Vascular Neurology Program

  • Multidisciplinary team for comprehensive care

    Our Pediatric Vascular Neurology Program brings together a team of specialists from many areas of Seattle Children’s to treat your child. Stroke treatment can be complex. Your child will benefit from the combined knowledge and skills of doctors, surgeons, pharmacists, nurses and therapists.

    The team coordinates care so your child gets treated for related conditions such as heart defects or blood disorders that increase the risk of blood clots or bleeding.

    Your child may see experts in: 

  • Here when you need us
    • 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.
    • In our clinics, we see children with symptoms that suggest a previous stroke and those who need follow-up care after a stroke.
  • Advanced diagnosis and stroke treatment
    • Our team has the experience to tell pediatric stroke from other health problems. This ensures your child gets the right treatment. In babies and children, many other conditions — like , infection or brain tumors — can look like a stroke.
    • Our pediatric and work together to choose the tests (imaging studies) needed to understand your child’s exact condition. We offer with if needed, so your child is calm and comfortable. Our specialize in caring for babies, kids and teens.
    • We offer a full range of treatments to fit your child’s needs. Options include medicines, surgery, treatment for underlying conditions and rehabilitation and neuropsychology, so your child has the best possible recovery.
    • We provide coordinated care to meet the complex needs of children with a condition that increases their risk of stroke or brain injury. These include moyamoya, cerebral cavernous malformations (CCMs), arteriovenous malformations (AVMs), , and sickle cell disease.
  • Research to prevent stroke and improve treatment
    • Seattle Children’s works with more than 100 centers in 34 countries on the International Pediatric Stroke Study (IPSS). IPSS centers combine medical information about hundreds of children who have had a stroke to look for patterns that may lead to better prevention, diagnosis and treatment.
    • Many of the doctors who will care for your child lead research to improve treatment and outcomes for children with cerebrovascular conditions. Our patients have the option to take part in research studies () of promising new treatments.
    • Some of the clinical trials we offer are funded by the National Institutes of Health. These include studies of the role of infection in pediatric strokes (VIPS), how seizures affect children who have had strokes (SIPS) and early corticosteroid treatment for children with certain conditions affecting brain blood flow (FOCAS).

    Learn about Seattle Children’s brain research.

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