May is American Stroke Month and Johns Hopkins All Children’s Hospital, in partnership with the American Stroke Association, is raising awareness about strokes in babies, toddlers, children and teens. A stroke is an injury to the brain caused by reduced or blocked flow in an artery supplying oxygen-rich blood to the brain. It generally is associated with older patients.
“Apart from 65 years and older patients, where the risk of stroke is high, the next most common time for stroke is unfortunately in the postnatal period,” says Neil Goldenberg, M.D., Ph.D., director of the Stroke Program at Johns Hopkins All Children’s Hospital. The program is part of a bi-campus Johns Hopkins pediatric stroke program that also includes the Johns Hopkins Children's Center in Baltimore, Maryland.
Strokes diagnosed shortly after birth are called perinatal stroke. Some strokes occur in utero (during pregnancy) and may not be recognized or diagnosed until several years of age. A stroke happens in about one in every 2,000 live births, which was the case for stroke patient, Eli, who is now 2 years old.
“I was shocked,” says Eli’s mom, Suzanne. “I would never have thought that my child would have a stroke.”
After a long and difficult labor, Suzanne needed to have an emergency cesarean section. Within the next few hours and coming days, Eli stopped breathing and started having seizures. A magnetic resonance imaging scan (MRI) showed that he had suffered a stroke.
“Some of the issues around difficult delivery may cause compression of the baby’s carotid arteries in the neck, which we think could predispose to a stroke,” Goldenberg explains. “In other cases, we think a clot could form either in the placenta or in the baby’s vascular system, and then break loose and travel (or 'embolize') to the brain circulation. However, much more research needs to be done to better understand the causes of perinatal stroke, and this is an active area of research in the Institute for Brain Protection Science at Johns Hopkins All Children's.”
Stroke prevention is very difficult, and while in many cases the causes are not identified, Goldenberg encourages families to speak up if something is wrong. As with Eli, intervention is key to preventing a stroke from progressing.
“If a full-term or near-term baby is having seizures in the first few days of life, make sure that the medical teams are aware that stroke is a relatively common cause and to evaluate with brain imaging,” Goldenberg explains.
It is also critical to receive the necessary post-stroke care from a multidisciplinary stroke program to have the best possible outcomes. Eli now receives physical, occupational and speech therapy on a regular basis and is a thriving, typical 2-year-old.
“He’s a happy, well-adjusted child,” Suzanne says. “I have to remind myself that this is a marathon, not a sprint.”
Eli will also soon be a big brother, as Suzanne is pregnant with twins.
“We just knew that our family wasn’t done growing yet,” Suzanne says. “I just have faith and statistically, thanks to Dr. Goldenberg, a stroke is probably not going to happen again.”
Stroke can also occur in children and teens, and symptoms include face drooping, arm weakness and speech difficulty. Learn more about the Stroke Program at Johns Hopkins All Children’s Hospital.