Diagnosis and Treatment

How Are Strokes Diagnosed?

The most important clues that would make a doctor think of a stroke are the symptoms a child is experiencing and how the child looks. If a doctor suspects that a child’s symptoms might be caused by a stroke, there are several ways to confirm the diagnosis. One of the most common tests doctors use is a head CT, which is a special type of X-ray that takes a picture of the brain. A child getting a head CT just has to lie still for a few seconds while the CT scanner takes a picture of the brain. A head CT does not hurt and does not take a long time to perform.

Another test is magnetic resonance imaging (MRI), which takes a picture of the brain without using X-rays. An MRI takes much more detailed pictures than a CT, and it is a much slower test. Children getting an MRI have to lie still for much longer than children getting a head CT, although it is a painless procedure.

If doctors need to take a closer look at the arteries that feed the brain, there are several tests they can use. A transcranial Doppler uses ultrasound waves, or sound waves we can’t hear, to look at the blood flowing through the arteries in the brain. For this test, a doctor holds a small ultrasound machine up against a child’s head for a few minutes in order to take a picture of the arteries in the brain. A transcranial Doppler is not noisy and does not hurt. An angiogram is a test that uses X-rays to take more detailed pictures of the arteries in the neck and head.

How are Strokes Treated?

Unfortunately, stroke cannot be cured. The brain cannot heal itself the same way the rest of the body does. If a tiny part of the brain is injured by stroke, that tiny part of the brain will never “grow back” or be the same as it was before the stroke happened.

Fortunately, the brain has other ways of responding to an injury. If a small part of the brain is permanently injured and cannot do its job anymore, other parts of the brain often “pitch in” and take over the job the injured part of the brain used to do. Retraining parts of the brain to do different jobs is slow, difficult work. This is why, for many children with stroke, the most important part of their treatment is neurorehabilitation, where children work with doctors, nurses, and special therapists who are experts in helping children retrain their brains. Neurorehabilitation includes many different therapies, such as physical or speech therapy, that are selected to treat individual symptoms.

For example, a child who has trouble with words will probably spend a lot of time working with a speech therapist. A child who has a weak left hand may work with a physical therapist to strengthen the hand. An occupational therapist might help the child relearn how to do things with the hand that are important to daily life, like using a zipper or holding a cup. Often, children with weak hands and arms get constraint therapy, in which a large mitten is placed on the strong hand to help a child practice using the weak hand.

Neurorehabilitation is hard work for kids and parents, and there is no guarantee that a symptom will ever completely go away. However, the effort is worth it because most children can significantly improve their symptoms with the proper rehabilitative therapy.

Other treatment options are specific to the individual child. For example, a child who has seizures because of a stroke might need anti-seizure medication. Some kids might need to take blood-thinning medication. And if a child has a medical condition that caused a stroke, that medical condition should be treated as well. Your doctor will explain to you what treatments will work best for your child.