In order to properly treat young patients and avoid medical malpractice, doctors must be knowledgeable about pediatric strokes. Any of the following may result in pediatric stroke medical malpractice:
- Failure to know and recognize pediatric stroke risk factors and causes of pediatric strokes
- Failure to know and recognize the symptoms of pediatric stroke
- Failure to diagnose or a delay in diagnosing pediatric stroke
- Failure to treat or a delay in treating pediatic stroke
Common Risk Factors for Stroke in Children
About 1 in every 4,000 children has a stroke at some point during birth. The risk of stroke from birth through age 18 is almost 11 in 100,000 children per year. Infant strokes (children under 2) are slightly more common than strokes in children over the age of 2. Boys and African-American children are at a higher risk for stroke than other groups.
High blood pressure, an irregular heartbeat, and hardening of the arteries are common causes of strokes in adults. These are rare causes of pediatric strokes. Common risk factors for stroke in children include:
- Congenital heart defects
- Sickle-cell disease
- Immune disorders
- Diseases of the arteries
- Abnormal blood clotting
- Head or neck trauma
- Maternal history of infertility
- Maternal infection in the fluid surrounding an unborn baby
- Premature rupture of membrane during pregnancy
- Pregnancy related high blood pressure in the mother
Types of Pediatric Strokes
There are general two types of strokes that children can suffer. Ischemic strokes occur when blood to the brain is blocked by an obstruction. These are sometimes called “dry strokes” because they result from a lack of blood flow to the brain. Hemorrhagic strokes occur when bleeding occurs in the brain. These are sometimes called “wet strokes” or “bleeding strokes” because they result in too much blood in the brain. Either type of pediatric stroke is an emergency and can result in permanent injury or death if the diagnosis or treatment is delayed.
What Causes Ischemic (Dry) Strokes in Children?
Doctors must quickly find the cause of a stroke in order to provide the right treatment and prevent more injury. Doctors can find a cause of strokes in about two-thirds of cases.
A common cause of ischemic strokes is that a blood clot forms in the heart and travels to the brain. This can be caused by congenital heart problems like abnormal valves or infections. In these cases children may need surgery or antibiotics.
Sickle cell disease is a blood disorder that is associated with ischemic stroke. In sickle cell disease, the blood cell can’t carry oxygen to the brain, and blood vessels leading to the brain may have narrowed or closed. About 10 percent of children with sickle cell disease suffer a stroke. Children with sickle cell disease have a high risk of repeat strokes, but this can be reduced by blood transfusion.
Finally, ischemic strokes can be caused by trauma that injures large arteries and causes a loss of blood flow. For instance, a large artery might be injured when a child has a neck injury.
In sum, the most likely causes of pediatric stroke are:
- lack of oxygen during birth
- a heart defect present at birth
- blood disorders such as sickle cell anemia, a disease that destroys blood cells and blocks blood vessels
- injury to an artery (a blood vessel that brings oxygen) in the brain
- genetic disorders like Moyamoya, a rare disease that affects arteries in the brain
- an infection, such as meningitis or chickenpox
Some problems that affect a mother during pregnancy can also cause a baby to have an ischemic stroke before or after birth. The most common examples include:
- preeclampsia (high blood pressure during pregnancy that can cause swelling in the hands, feet, and legs)
- premature rupture of the membranes (when a woman’s water breaks more than 24 hours before labor starts)
- drug abuse
- placenta problems that decrease the baby’s oxygen supply, such as placental abruption (when the placenta peels away from the inner wall of the uterus)
It is important for doctors treating pregnant women to be on the lookout for these disorders in order to prevent pediatric strokes before or after birth.
What Causes Hemorrhagic (Bleeding) Stroke in Children?
When a blood vessel on or in the brain ruptures, blood flows into brain areas where it’s not supposed to go. It may pool in brain tissues, resulting in a blood clot. Also, because the vessel is ruptured, blood isn’t transported where it should go. As a result, the brain is deprived of oxygen, and this may lead to permanent brain injury. Hemorrhagic strokes are most often caused by rupturing or weakened or malformed arteries known as arteriovenous malformations (AVMs).
The risk of hemorrhage is higher with certain illnesses such as hemophilia. Hemophilia is a disorder where the blood does not properly clot. Hemophilia is a leading cause of pediatric stroke.
Hemorrhagic strokes can be caused by:
- a head injury that results in a broken blood vessel
- arteriovenous malformation, a condition in which the blood vessels in the brain don’t connect properly
- an aneurysm (weakness in an artery wall)
- diseases that affect blood clotting, such as hemophilia
To avoid medical malpractice for a failure to diagnose or a failure to treat pediatric stroke, doctors must understand, recognize, and address these risks.
Different Symptoms For Strokes in Children
Because people don’t often think about newborns and children having strokes, pediatric strokes often go unrecognized or are not treated properly. Another challenge with newborns is that they cannot communicate symptoms that are not readily visible.
The common stroke warning signs—FAST—used to identify stroke in adults can also be used to identify strokes in children.
But, there are some specific symptoms that you should look for in children depending on their age.
Signs of pediatric stroke in newborns and infants include:
- Extreme sleepiness
- Tendency to use only one side of their body
Signs of pediatric stroke in children and teens include:
- Severe headaches
- Loss of balance or coordination
It is critical that pediatric strokes get immediately diagnosed and treated. A delayed diagnosis of pediatric stroke or delayed treatment for pediatric stroke may cause permanent injuries or even death.
Diagnosing Stroke in Children
Sometimes stroke can be diagnosed based on a child’s signs and symptoms. For example, if a childhood suddenly loses strength on one side of his body or has difficulty speaking, a stroke may be immediately suspected. Other types of pediatric strokes may be more difficult to diagnose.
Strokes that occur before birth (perinatal strokes) and infant strokes can sometimes be hard to diagnose. This is especially true if a child has no obvious signs or symptoms. In some cases, a stroke may be diagnosed as the cause of a child’s seizures or developmental delays only after other conditions have been ruled out. This might mean that a child will undergo several tests before the doctor even mentions the word “stroke.”
If a stroke is suspected, a doctor will probably need the child to undergo one or more of these medical tests to confirm the diagnosis of pediatric stroke:
- Blood tests
- Magnetic Resonance Imaging (MRI): a safe and painless test that uses magnets, radio waves, and computer technology to produce very good pictures of internal body parts, such as the brain
- Magnetic Resonance Angiography (MRA): an MRI of specific arteries
- magnetic resonance venography (MRV): an MRI of specific veins
- Computed Tomography Scan (CT or CAT scan): a quick and painless test that produces pictures of bones and other body parts using X-rays and a computer
- Computed Tomography Angiography (CTA): an X-ray of specific arteries
- Cranial Ultrasound: high-frequency sound waves that bounce off organs and create a picture of the brain
- Lumbar Puncture (a.k.a. spinal tap): a needle is injected into the lower back to remove and test cerebrospinal fluid (CSF)
If a child has signs or symptoms of a stroke and a physician does not order the tests to diagnose and treat pediatric stroke, the doctor may have committed medical malpractice. In such a case, the doctor may be responsible for any injuries the child suffered due to the delayed diagnosis of stroke.
Treatment for Strokes in Children
Children usually recover better from strokes than adults do because their brains are still growing. However, children can experience permanent complications from stroke, such as seizures, weakness, and vision problems.
Treatment for pediatric stroke depends on the specific cause. Some common stroke treatments used with adults are not appropriate for young children and infants. One of the best treatments for ischemic (dry) strokes for adults is tPA, or tissue plasminogen activator. TPA is a blood thinner that dissolves blood clots.
TPA is rarely used for pediatric stroke. Use of tPA for pediatric stroke is controversial and limited to clinical trials.
Current treatments for pediatric stroke include:
- Supportive care to maintain normal body temperature, proper hydration, and normal blood sugar levels
- Controlling high blood pressure
- Detecting and treating seizures with EEG monitoring and anticonvulsant medication
- Managing intracranial pressure
- Blood transfusions for children with sickle-cell disease
- Antithrombotic therapy, which refers to medications used to prevent blood clots from forming or growing, is used in children but generally not infants
- Surgery related to hemorrhagic stroke (and less commonly, ischemic stroke) is sometimes performed to relieve pressure on the brain
If someone you know someone has suffered a pediatric stroke – or any stroke – it is critical that you speak with a stroke lawyer as soon as possible to evaluate your options.
Young Stroke Survivors
Strokes in young people are becoming more common. Recent data shows that about 15% of the most common kind of stroke – ischemic or “dry” stroke – occur in young adults or adolescents. There was a 44% increase in the number of hospitalizations for young people due to stroke in the last decade. Many stroke survivors are not the elderly people we would typically expect. Rather, they are young people who are between the age of 15 and 35.
The family burdens and financial obligations caused by a stroke in a young person can be tremendous. In many instances they are far greater than when a stroke occurs in an older person. The reason that overall cost is greater for a young person is because they will likely need a lifetime of care, as opposed to just care at the end of their life. Also, when a stroke hits a younger person, they likely are in the workforce or would be in the workforce if they did not have the stroke. This means that they are financially worse off than if they had the stroke later in life.
Given these realities, lawsuits for stroke medical malpractice are frequently that much more important for child and adolescent stroke survivors.
Can I File A Medical Malpractice Lawsuit for a Pediatric Stroke?
Yes. A lawsuit for an ischemic or “dry” stroke just is like any other medical condition. If you think that a doctor or hospital was negligent in diagnosing, treating, or preventing a stroke in an infant, a child, or an adolescent and it caused an injury, a medical malpractice or negligence lawsuit should be investigated. If you would like us to investigate your stroke medical malpractice lawsuit, you will need to act quickly. There are short time restrictions for filing a lawsuit for medical malpractice or negligence, including for a stroke involving an infant, a child, or an adolescent patient.
Pediatric Stroke FAQs
Here are some common questions and answers about pediatric stroke.
Do You Strokes Happen in Children?
Yes. While most people think that strokes only happen in adults, strokes happen in infants, children, teenagers, and unborn babies.
What are the Different Types of Pediatric Strokes?
There are generally two types of strokes.
One kind of stroke is called an ischemic stroke or “dry stroke” because it is caused by a blood clot that prevents blood from flowing to the brain.
The other kind of stroke is called a hemmorhagic stroke of “bleeding stroke.” Hemmorhagic strokes occur when a blood vessel has burst and has begun to deposit blood in the brain tissue or in the space outside of the brain.
What are the Different Categories of Pediatric Strokes?
Perinatal refers to the time period last from 18 weeks before childbirth to the first 30 days after birth. Other similar terms are also sometimes used to cover this time period. Those terms typically include in utero, prenatal, and fetal stroke and are limited to the time before birth. The terms newborn and neonatal stroke refer to strokes that occur during the first month of life.
Childhood stroke refers to a stroke that occurs after one month of life and before the 18th
Is Stroke in Children ever Delayed or Misdiagnosed?
Yes, stroke is often delayed or misdiagnosed in children. A misdiagnosis of stroke increases the risk of injury.
How common is pediatric stroke?
Pediatric stroke is more common that you might think. It is as common as brain tumors. Stroke is a leading cause of death in children.
What Percentage of Children Will Have Permanent Injuries from Stroke?
About 60% of children who survive a stroke will have permanent function limitations. These are called neurological deficits because they are caused by damage to the brain.
The most common types of limitations are hemiparesis or hemiplegia. Hemiplegia/hemiparesis (total or partial paralysis on one side of the body) is the most common form of cerebral palsy in children born at term. Cerebral palsy is caused by a lack of brain development. Stroke is the leading cause of cerebral palsy.
Hemiplegia / hemiparesis are not the only long-term disabilities caused by stroke. Other long-term disabilities caused by a stroke in childhood include cognitive and sensory impairments, epilepsy, speech or communication disorder, visual disturbances, poor attention, behavioral problems, and poor quality of life.
Facts About Perinatal Stroke
The majority of pediatric strokes occur in the perinatal period.
To many people’s surprise, the most focused period of risk for ischemic stroke in your lifetime is the week you are born.
In most perinatal strokes, a cause cannot be found.
For perinatal strokes, the overall risk for another stroke is extremely low, < 1%.
Showing a hand preference, or consistently reaching out with only one hand before 1 year of age may be an indication of an earlier perinatal stroke.
When stroke affects a newborn infant, symptoms may not appear until 4 to 8 months of age in the form of decreased movement or weakness of one side of the body.
Cerebral Palsy (CP) refers to a motor (physical movement) difficulty which results from an abnormality or injury to the brain before or around the time of birth. Therefore, for stroke, the term CP only applies to perinatal stroke. The term CP is not correct for childhood stroke though many children share similar neurological problems (i.e. weakness on one side).
Facts About Childhood Stroke
For children who have an initial stroke, the risk for recurrent strokes is between 15% and 18%.
Early recognition and treatment during the first hours and days after a stroke is critical in optimizing long-term functional outcomes and minimizing recurrence risk.
Many children with stroke symptoms are misdiagnosed with more common conditions that mimic stroke, such as migraines, epilepsy or viral illnesses.
What Groups Are At Risk for Pediatric Stroke?
Newborns, especially full-term infants
Older children with sickle cell anemia, congenital heart defects, immune disorders or problems with blood clotting
Previously healthy children who are found to have hidden disorders such as narrow blood vessels or a tendency to form blood clots easily
Signs and Symptoms of Pediatric Stroke
Strokes have different signs and symptoms depending on the age of the stroke patient. The most common signs and symptoms of stroke include the sudden appearance of:
Signs and Symptoms of Stroke In Children and Teenagers
Weakness or numbness of the face, arm or leg, usually on one side of the body
Trouble walking due to weakness or trouble moving one side of the body, or due to loss of coordination
Problems speaking or understanding language, including slurred speech, trouble trying to speak, inability to speak at all, or difficulty in understanding simple directions
Severe headache especially with vomiting and sleepiness
Trouble seeing clearly in one or both eyes
Severe dizziness or loss of coordination that may lead to losing balance or falling
New appearance of seizures, especially if affecting one side of the body and followed by paralysis on the side of the seizure activity
Combination of progressively worsening non-stop headache, drowsiness and repetitive vomiting, lasting days without relief
Complaint of sudden onset of the “worst headache of my life”
Signs and Symptoms of Stroke In Newborns and Infants
A tendency to use only one side of their body
What Specialists Treat Pediatric Stroke
A pediatrician is a primary care physician who specializes in the treatment of infants and children. Pediatricians can often help coordinate multiple issues with child’s general health
Rehabilitation specialists include doctors such as physiatrists (also called Physical Medician and Rehabilitation Specialists) and developmental pediatricians with expertise in child rehabilitation
Speech Language Pathologist
Speech language pathologists are part of the stroke team for assessment and help with speech or language challenges that often occur after stroke.
Neuropsychologists evaluate patients and help with learning and education needs.
There is a tremendous amount of stress that is involved in being a child who has experienced a stroke or in having a child who has had a stroke. Psychologists can help with the stress that is associated with this psychological stress.
Orthopedic surgeons are often involved in helping what are called the “mechanical” complications of stroke. These include issues such as tightness in the arm or leg that might be helped by surgery
A hematologist is a blood specialist. A hematologist tests the blood for rare clotting disorders called “hypercoagulable states” and rare diseases that can cause pediatric stroke.
A neonatologist is a pediatrician who specializes in the care of newborn babies. They are usually involved in the care of acute neonatal strokes.
Sometimes neurosurgeons are involved in the treatment of strokes that can be treated with brain surgery. These tend to include hemorrhagic strokes caused by aneurysms and arteriovenous malformations (AVM).