When Anthony, an 11-year-old boy, was doing leg lifts during baseball practice, he experienced numbness in his left leg. Anthony's coach checked on him, noticing that he could not get up and move his left side. The coach's wife had previously suffered a stroke at 40, so he was familiar with the symptoms. He immediately called 911, informing the paramedics that he believed Anthony was having a stroke.
Strokes are quite rare in children, affecting approximately 12 in 100,000 children under the age of 18. However, when they do occur, they can have severe consequences, potentially leading to lifelong disability or even death. Strokes happen when the blood supply to the brain is interrupted. There are two primary causes. Arterial ischemic strokes (AIS) happen when a blood clot or a narrowed blood vessel reduces or blocks the blood supply to the brain. Strokes can also be caused by intracranial hemorrhaging, which happens when blood vessels in the brain rupture, leading to bleeding in the brain.
"Partly because they are so rare, many pediatric strokes actually go undiagnosed or the diagnosis is delayed," explains Navdeep Sangha, MD, the Kaiser Permanente Southern California regional physician director of stroke and telestroke.
What are the warning signs of pediatric stroke?
The symptoms of stroke may include seizures, extreme sleepiness, or a tendency to use only the right or left side of the body. In children under 18, the early warning signs include:
• Weakness, numbness, or drooping usually on one side of the body
• Trouble walking or moving one side of the body
• Slurred speech or inability to speak or understand
• Severe headache
• Severe dizziness or loss of coordination
• Unusual drowsiness
• Repeated vomiting
• Seizures
To encourage greater public awareness, experts devised the simple acronym F.A.S.T., which stands for facial drooping, arm weakness, speech difficulties, and time (because time is of the essence when a stroke occurs).
What treatment did Anthony receive?
Anthony was swiftly transported to the Kaiser Permanente Ontario Medical Center due to acute stroke symptoms. The medical team promptly identified his condition and activated a code stroke. Omer Khayali, MD, a neurologist at Kaiser Permanente, urgently examined Anthony via the Telestroke Cart. After reviewing the CT scans, Dr. Khayali transferred Anthony to the Kaiser Permanente Fontana Medical Center for a thrombectomy. A thrombectomy is an interventional procedure designed to remove a blood clot from within an artery or vein.
The patient's Door in Door Out (DIDO) time, which is the time from when the patient arrived at the Emergency Department at Kaiser Permanente Ontario Medical Center to when the ambulance departed to transport him to Fontana, was an impressive 37 minutes. This is significantly faster than the national median time of 130 minutes (about 2 hours) for any emergent ischemic stroke transfer.
Upon the patient's arrival at Kaiser Permanente Fontana Medical Center, Robin Shaw, the local Kaiser Permanente San Bernadino Stroke Coordinator, who had been informed about the case in advance, made a special effort to be present in the Emergency Department after regular hours to ensure everything proceeded smoothly.
The patient was in the Interventional Radiology suite within 18 minutes, had a groin puncture within 49 minutes, and recanalization within 77 minutes. These times are extraordinary, especially considering that this was a child with two complex cerebrovascular occlusions causing the stroke.
The rapidity of care likely saved him from a lifetime of disability. The longer the delay in diagnosing and treating a stroke, the higher the risk of irreversible brain damage. Experts believe that increased awareness about the risk and symptoms of pediatric stroke could help reduce its impact.
How long does it take to recover?
Recovery duration following a stroke varies greatly among individuals—it can span weeks, months, or even years. Some people regain their full health, while others may face long-term or permanent disabilities. Getting to the hospital quickly and receiving interventions specifically designed for stroke care can aid many individuals increase their chances for a better recovery from a stroke. In Anthony's situation, his recovery was expedited due to his young age, swift medical attention he received that resulted in the final stroke being small. His future is not expected to be heavily restricted; he is likely to return to the baseball field within three months.
"Having a stroke as a child was unfortunate. However, through my personal journey and recovery, I aspire to support other children who undergo a stroke," Anthony shares, reflecting on his experience of suffering a stroke at the tender age of 11.
What can you do?
Anthony's triumph over stroke is largely due to the people in his life who were well-informed about the symptoms of a stroke. His coach, who was quick to identify the signs and immediately called 9-1-1, and the EMT, who was trained by Kaiser Permanente to spot stroke symptoms in children, played pivotal roles. Their prompt actions significantly cut down the time it took for Anthony to receive medical attention. Timely diagnosis is of the essence. Strokes can occur even in our younger patients, and there is a need for more education on pediatric strokes. We urge you to study this stroke flyer to be able to identify if someone in your vicinity is having a stroke. If you observe someone showing signs of a stroke, call 9-1-1 without delay. Rapid admission to the hospital is key to effective stroke treatment and recovery.
Overall, a child’s growing brain has a better chance of recovering from stroke than an adult’s brain. Prompt diagnosis and treatment can minimize the risk of lasting problems, and early rehabilitation can help maximize recovery.