Pediatric stroke: developing a better understanding through research

chh_2780_300x250Today at 10 A.M. Children’s Hospital Boston will broadcast online a live neurosurgery operation where doctors will treat a young patient with a rare neurological condition called moyamoya disease. In addition to providing the virtual audience with an up close view of surgeons performing a cutting edge treatment developed at Children’s, a panel of experts will comment on the procedure offering insight to the treatment, the disease itself and other related topics.

One of the panel’s speakers will be Michael Rivkin, MD, director of the Cerebrovascular Disorders and Stroke program at Children’s Hospital Boston, who will discuss cerebrovascular diseases and stroke treatment at Children’s. While pediatric stroke is a very serious risk for patients with moymoya, these patients are not the only children who can experience a stroke. Many children are at risk and research on the causes and treatment of pediatric stroke is still a developing field in pediatrics.

“There are a number of things that could cause a child to have a stroke, but usually those causes are different ones than those found in adult stroke,” Rivkin says. “Historically speaking, conditions such as congenital heart disease, coagulation system defects and trauma have all been associated with pediatric strokes, but we now know that causes of inflammation, like an upper respiratory tract infection or a bacterial or viral illness, can increase a child’s risk of having a stroke. The reason why this association exists remains elusive.”

Michael Rivkin, MD
Michael Rivkin, MD

Rivkin says one of the hardest parts about treating pediatric strokes is late diagnosis. Because many people still do not associate children as being vulnerable to strokes, when they do occur in pediatrics they often aren’t recognized until a good deal of time has passed. “Too often kids with strokes are not recognized as having one until a nearly a day after it occurred,” he says. “That means many of the acute therapies that are used on adult stroke patients can’t even be considered for use in these children.  More rapid diagnosis is not only critically important but also urgently needed.”

One factor contributing to these late diagnoses is that pediatric stroke can be easily mistaken for a seizure disorder in young children. It’s not uncommon for a seizure to accompany a stroke, or for a stroke to be confused for a seizure, because they share many of the same symptoms— most notably a weakness and/or tingling sensation on one side of the body.

“If a child’s stroke causes a seizure— and the following weakness is stroke-related but doctors assume it is seizure-related— proper diagnoses can take longer, in which case it may be too late to implement hyper acute treatment for stroke,” he says. “If a child who has no previous history of seizure comes in with a first seizure and has weakness on one side of the body I think clinicians should consider the possibility of pediatric stroke. There’s a good chance it won’t be, but you still need to entertain the thought.”  

 Of all the ages in childhood, Rivkin says the neonatal period of a person’s life is when he or she is most susceptible to pediatric stroke. This could be attributed to the relative immaturity of a newborn’s coagulation system, or to certain interactions between the fetus and the placenta which have also been associated with the risk for stroke in children of this age group. Even though research has explained some triggers of pediatric stroke, Rivkin says there are still a significant number whose causes remain a mystery and that only more research will help doctors in treating and preventing them. “There is substantial proportion of neonatal stroke and stroke in older children that goes unexplained,” he says. “This underscores why there is a need for continued research in this area.”