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Stroke is a neurological injury caused by the occlusion or rupture of cerebral blood vessels. Strokes are primarily classified as ischemic, hemorrhagic or combination (e.g. thrombotic stroke with hemorrhagic transformation)

Historical Aspect

Pediatric stroke was reported in the earliest medical literature as ‘cerebral apoplexy’ ‘acute infantile hemiplegia’ ‘acute hemiplegia of childhood’ ‘congenital hemiplegia’ and ‘hemiplegic cerebral palsy’.

The first documented case of pediatric stroke in the medical literature was presented by Thomas Willis (1621–1675) in the 17th century.

Giovanni Battista Morgagni’s (1682–1771) proposed that lesions occur in the brain opposite the site of hemiplegia.

Matthew Baillie (1761–1823), first described cerebral hemorrhage as the consequence of disease of the blood vessels of the brain.


Hemorrhagic stroke occurs when intracranial vessels rupture and bleed into cerebral tissues due to malformation, traumatic injury, and/or bleeding diathesis, or coagulopathies. Cerebral venous sinus thrombosis results in back pressure and leakage of blood into brain tissue, or loss of flow into areas of the brain due to the higher pressure.

Ischemic strokes result from an interruption in blood flow due to inadequate systolic cardiac function, inappropriate vasoconstriction, or thromboembolic occlusion of a vessel.

Epidemiology including risk factors and primary prevention

The estimated incidence of stroke in children ranges from 2 to 13 per 100,000 children per year.1

Incidence of pediatric stroke can be categorized by age at onset, etiology, and ethnicity.

Pediatric Stroke based on age is subgrouped into:

  • Perinatal stroke: A stroke which occurs before 29 days of life.2 The incidence of perinatal stroke is 1 in 2300 to 5000 births.3
  • Childhood stroke: A stroke which occurs between 29 days and 18 years of age.2 Childhood stroke has an incidence of 2-13 per 100,000.4

Pediatric Stroke by etiology:

  • Hemorrhagic Stroke: A retrospective cohort study of 2.3 million children (age <20 years) followed for more than a decade revealed an average annual incidence rate of 1.4 per 100,000 children for hemorrhagic stroke. Among hemorrhagic stroke subtypes, the estimated annual incidence of intra cerebral hemorrhage in developed countries ranges from 1.1 to 5.2 per 100,000 children, while the estimated annual incidence of subarachnoid hemorrhage is 0.4 per 100,000 children. Hemorrhagic strokes occur more frequently in older children.5 Around 40% of pediatric stroke hospitalizations are due to hemorrhagic stroke.6
  • Ischemic Stroke: Annual incidence rates of arterial ischemic stroke (AIS) in infants and children range from 0.6 to 7.9/100,000 children per year. AIS is more common in the younger age group and in males.5 Approximately 55% of pediatric strokes are ischemic, (in adults, greater than 80%). Basilar artery stroke: 0.037 per 100,000 children per year.7 Around 60% of pediatric stroke hospitalizations are due to ischemic strokes.6

Pediatric Stroke by ethnicity:

  • Asians and African American have higher risk of Arterial Ischemic Stroke (AIS).8
  • African Americans are affected more commonly than Caucasian or Hispanics even when corrected for sickle cell disease. Sickle cell disease (SCD) is a very common cause of pediatric stroke. 11% of patients with Sickle cell disease will have a clinically apparent stroke by age of 20 years. Strokes may occur as early as 18 months of age, but most children present after five years of age. 25% of patients with Sickle cell disease will have a stroke by age 45.9

Risk factors include1,5

Ischemic Stroke: (Pediatric Stroke: Current Diagnostic and Management Challenges)10

  • Dehydration
  • Hypoxia or Acidosis
  • Arteriopathies (Focal Cerebral Arteriopathy, Arterial Dissection, Vasculitides and Moyamoya)
  • Cardiac Disease (Arrhythmia, Congenital Conditions, Cardiac Surgeries)
  • Prothrombic Disorders
  • Sickle Cell Disease
  • Infection or Sepsis
  • Thrombophilia
  • Asians and African Americans
  • Male Sex

Hemorrhagic Stroke:

  • Vascular Disorders (AV Malformations, Aneurysms, Moyamoya)
  • Clotting Disorders (Platelet Disorders, Inherited Bleeding Coagulopathies, Anticoagulant Therapy)
  • Sickle Cell Disease
  • Drug Use (Cocaine and Methamphetamines)
  • African Americans
  • Male Sex

Predisposing factors

In the case of pediatric AIS2., predisposing factors include mineralizing angiopathy and mild trauma immediately or shortly preceding stroke onset.5

Predisposing factors for hemorrhagic stroke include vascular and coagulopathy abnormalities like arteriovenous malformation, and trauma.11,12

Primary prevention in select populations:

  • Sickle cell disease: Periodic blood transfusion is recommended to reduce risk of first stroke if two transcranial Doppler studies demonstrate high velocity flow in the middle cerebral artery or distal internal carotid artery.7,13  Use of hydroxyurea is indicated to prevent sickling.
  • Administering folic acid, niacin and B12 in an effort to normalize homocysteine levels is beneficial.
  • Cardiac: Aspirin and anti-coagulants have been used to reduce the risk of cardiac origin stroke. Surgical repair can reduce risk of embolic stroke.13
  • Activity precautions in patients with stroke resulting from bleeding diathesis, or coagulopathies, especially resistive exercises
  • Routine vaccines have been shown to protect against pediatric stroke. This is thought to be due to the direct protective effects of vaccination against infections. One reason why infection may lead to increased risk of pediatric stroke is due to the increase in systemic inflammation and activation of the coagulation cascade, so vaccinations decrease the risk of systemic inflammation due to infections. The study was unable to show if any one vaccine was more protective, rather it is thought that overall vaccinations are protective.14


The middle cerebral artery is the most commonly affected distribution in ischemic strokes. Hemorrhagic strokes are typically supratentorial. Cerebral venous sinus thrombosis occurs more often in the superficial venous system than within the deep veins.1

On a cellular level, ischemic changes precipitate a series of events that result in tissue necrosis. Cell injury leads to activation of enzymes that degrade the cell’s proteins, genetic material, and lipids. The injured cells also trigger further cellular injury through activation of N-methyl-D-aspartate receptors and formation of reactive oxygen species. Soon after the initial insult, there is an influx of inflammatory cells to the site of injury. Further changes take place in the area surrounding the ischemic focus over subsequent hours to days.1

Disease progression including natural history, disease phases or stages, disease trajectory (clinical features and presentation over time)

New onset/acute 1,6

  • Abrupt onset of focal neurologic signs or rapid decline in neurologic function.
  • Altered mental status or seizure may be the only presenting symptom. In Intracranial hemorrhage: nausea, vomiting, and headache.
  • One study found seizures to be present in 94% of neonatal AIS and in 17% of childhood AIS.15
  • Signs and symptoms may be subtle, especially in infants. Nonspecific symptoms seen in pediatric stroke, include decreased level of consciousness, headache, and vomiting. 8   However, hemiparesis and facial weakness, similar to adult presentation, is often seen. Despite this, the diagnosis of Pediatric Stroke is commonly delayed. 8  This is in part due to poor awareness among professionals about pediatric strokes because of low prevalence, keeping pediatric stroke lower on the differential, and the risk factors for children are very different than that of adults.8  One study showed that the median time from symptom onset to diagnosis of AIS was around 23 hours.16
  • FAST (“Face, Arms, Speech Time) criteria is a method to screen for stroke (Royal College of Pediatrics and Child Health Full Recommendations for Childhood Stroke).17


  • Patients who have had previously unrecognized or misdiagnosed strokes may present in the subacute period with a history of stepwise or progressive decline in function over time.


Most studies estimate that over 50% of pediatric stroke patients will have long-lasting or permanent neurologic sequelae.13

In one study, the majority of pediatric stroke patients achieved independence with activities of daily living (ADL). However, children were more likely to regain function in a previously learned domain than achieve a new skill. Thus, younger age is a risk factor which may limit progress in ADL independence. 9

In the chronic phase, regression in function is rare.9 Recurrent stroke should be suspected if a child develops new deficits.

Morbidity and Mortality: Pediatric stroke leads to significant morbidity and mortality. Roughly 10–25% of children with a stroke will succumb to death. Up to 25% of children may have recurrence, mostly due to an underlying etiology, and up to 66% will have persistent neurological deficits or develop subsequent seizure disorders, learning, or developmental problems.

Specific secondary or associated conditions and complications

Sequelae of pediatric stroke may include:

  • Seizure disorder
    • Epilepsy-Can be as high as 50% 18  
    • Infantile Spasm-around 25% 18
  • Cerebral Palsy19
  • Hemiplegia/quadriplegia.
  • Spasticity.
  • Muscle contractures.
  • Visual deficits.
  • Speech and language impairment.
  • Dysphagia-around 40% in neonates and children20
  • Oral motor-around 25% in children and neonates20
  • Motor speech-around 25% in children and neonates20
  • Cognitive impairment.
  • Head Growth Deceleration-associated with poor outcomes19
  • Obstructive Sleep Apnea21

All the above may impact a child’s mobility and/or independence with activities of daily living.

Essentials of Assessment


A thorough history in a child with suspected stroke should include:

  • Time of symptom onset.
  • Specific sensory or motor deficits, vision changes, dysphagia.
  • Seizure activity.
  • Headache.
  • Trauma.
  • Screening for potential risk factors, including recent infections.
  • Birth and developmental history
  • Family history of clots, miscarriages, drug exposure

Physical examination

Initial examination:

  • Closely monitor vital signs acutely.
  • Document seizure activity.
  • Look for signs of increased intracranial pressure, such as papilledema.
  • A full neurologic exam should be completed, including mental status, cranial nerves, motor function, sensory testing, reflexes, and coordination. Later stages: assess ADL skills, transfer skills, other functional mobility.

Functional assessment

The Pediatric NIH Stroke Scale (PedNIHSS) can be used to quantitate stroke severity in the short-term and is adapted for the pediatric population. A guide to using the scale is available online.22

The Pediatric Stoke Outcome Measure (PSOM) is a validated tool used specifically for the pediatric stroke population.23  PSOM is used to predict future long-term functional outcomes after a stroke.24  Poor PSOM scores at 1 month has correlated with decreased functional motor and gross motor function and adaptive skills at 12 months after the stroke.25

Laboratory studies

Laboratory studies that may facilitate the evaluation of a patient with suspected stroke include:

  • A complete blood count (anemia, platelet disorders). If abnormal, peripheral blood smear to further characterize.
  • A metabolic panel (electrolyte abnormalities, dehydration).
  • Coagulation panel (APTT, PT, lupus anticoagulant, anti-cardiolipin antibodies, ANA, anti-B2GP1 antibodies, platelet aggregation, factor VIII activity, d-dimers, thrombin time, factor V Leiden, Protein C antigen, Protein S antigen, Plasminogen activator inhibitor, homocysteine, coagulation factor assays)
  • Inflammatory markers including sedimentation rate and C-reactive protein (inflammatory or infectious conditions).
  • Maternal labs for syphilis testing (VDRL, toxicology screen)


MRI, when available, is preferred for first line imaging study for a child with stroke like symptoms.26 If MRI is not available, then CT or head ultrasound can be used.27

The optimal imaging study is somewhat dependent on the child’s clinical stability.

Cranial ultrasound is safe and readily available, but it may miss superficial and ischemic lesions and cannot be done after the fontanelles are closed. It is primarily used to evaluate extra cranial blood vessels.

CT brain quickly and accurately depicts superficial or hemorrhagic lesions and confirms the lesion location. However, venous thrombosis and early acute ischemic stroke (AIS) are easily missed with CT. Reports have shown CT can miss up to 47% of acute ischemic strokes. 26

MRI, magnetic resonance angiography (MRA), and magnetic venography (MRV) may more accurately define the site of an arterial or venous occlusion. Additionally, MR studies often demonstrate associated parenchymal abnormalities more clearly, including non-ischemic lesions that clinically mimic arterial or venous stroke.

CT/MRI differentiates hemorrhagic verses ischemic lesions which also guide in formulating plan for using thrombolytics which are contra-indicated in hemorrhagic strokes

Diffusion-weighted imaging (DWI) can confirm the presence and location of an infarction earlier than other MRA sequences or CT. This DWI study can be performs in around 30 seconds. 26

Other advancing MRI techniques include pH-weighted arterial spin labeling (AST), amide proton transfer (APT), vessel wall imaging, bold oxygen level-dependent (BOLD), T2-relaxation-under-spin lagging, asymmetrical spin echo and edited spectroscopy.26

CT angiography (CTA) is an accurate means of identifying primary vascular abnormalities when there is an unexplained hemorrhagic lesion. CTA can fail to differentiate between a stroke and a stroke mimic, like hemiplegic migraine and seizure with postictal paralysis. CTA requires a correctly time contrast injection through a small intravenous line while exposing a child to increased radiation making it not recommended as the first line approach.26

Catheter angiography (CA) is technically more difficult in babies and tends to be done only when endovascular surgical intervention is anticipated.

Vascular imaging by MRI or CTA is done either at the same time or after the initial imaging study due to the high likelihood of an arteriopathy, which is a poor prognostic factor and has a higher chance of stroke recurrence. Follow-up imaging 6 to 12 weeks after the initial stroke is recommended to monitor arteriopathy changes or to find previously missed arteriopathy and/or new infarcts.2

Supplemental assessment tools

EKG and echocardiogram should be obtained after acute ischemic stroke (arrhythmia, thrombus, or congenital cardiac defects).1

Generalized activity suppression or subtle presentation of focal seizure activity can be seen on EEG.

Neuropsychology testing plays an important role in assessing cognitive and memory deficits.

Early predictions of outcomes

For ischemic strokes, a low PedNIHSS is the best predictor of having no symptoms or mild symptoms in 3-6 months.28

Hemorrhagic strokes cause higher mortality in the acute phase. Most studies have found an in-hospital mortality rate of 6-9% for pediatric hemorrhagic strokes.28 Larger volume of hemorrhage correlates to worse 30-day outcomes.29


Prior to discharge, consider the physical accessibility of the child’s discharge destination. A thorough discussion with caregivers may help to identify additional equipment or home adaptation needs.30

Social role and social support system

After assessing the child’s mobility, independence with activities of daily living, speech, and cognitive changes, caregivers may find that the child will need more frequent assistance or more intensive care than they previously required. Functional parenting styles, positive discipline practices, and autonomy-supportive strategies for task engagement should be encouraged when intervening with these children. Parents should be supported to engage in these practices in all aspects of daily activities.31

Mentoring support groups such as hemi-kids and CHASA are available in the community.

Mental health illnesses are a concern in both the child and the family members. In the child post stroke depression, anxiety and Post-traumatic stress disorder (PTSD) are common. PTSD, depression and anxiety are common in the mothers, while PTSD and depression are seen in fathers of children after a stroke.32

Rehabilitation Management and Treatments

Available or current treatment guidelines

Meta-analysis of peer-reviewed research is limited in the pediatric stroke population.

In 2019 the American Heart Associate released their “Considerations for Clinical Practice” for pediatric rehabilitation which states:

  • “Age-appropriate rehabilitation and therapy programs are appropriate for children after a stroke.”
  • “Psychological assessment to document cognitive and language deficits is useful for planning therapy and educational programs after a child’s stroke.”
  • “Constraint therapy should be considered in children with unilateral hand dysfunction after AIS.”
  • “Long-term follow-up is required for children with stroke to assess for development of new cognitive, physical, and emotional concerns that may occur over time as children grow into deficits.”33

Other recommendations by the AHA include:

  • Use constraint therapy for upper extremity strength
  • Long-term antithrombotic therapy can be used to prevent recurrent strokes
  • Perform a physiological assessment for cognitive and language deficits
  • Follow-up long term for new concerns as children grow into their deficits

 In 2015 the Canadian Stroke Best Practice Recommendations: Stroke Rehabilitation Practice Guidelines released recommendations care in the pediatric population, as listed below.34

Pediatric Stroke Recommendations
Level A
Arm and Hand RehabilitationUse Constraint-Induced Movement Therapy for upper limb impairment
Pediatric Stroke Recommendations Level B
Rehabilitation AssessmentAn initial assessment by medical professionals should be done quickly to determine stroke severity and rehabilitation needs
 Provide acute and rehabilitation stroke care on a specialized pediatric unit
 Offer outpatient support to children who have a change in functional status and would benefit from more rehabilitation services at any time during their recovery
Rehabilitation TeamCare should be given by health professionals who have experience in pediatric stroke care, regardless of the location of services to decrease complication risk
 Teams should have experts in pediatrics, pediatric stroke rehabilitation, including physicians, occupational therapists, physical therapists, speech-language pathologists, nurses, social workers, psychologists, and dietitians
Family WellnessProvide educational interventions to reduce maternal guilt or parental blame
 Educate parents, particularly mothers, about causes of pediatric stroke and that it almost impossible to prevent
 Tell mother directly and repeatedly “This is not your fault”
 Offer families support and information relating to changes in physical needs and dependency of the child
 Other changes that should be addressed include family members social roles, leisure activities, impact on family members, and issues that may arise with resources
Pediatric Stroke Recommendations Level C
Rehabilitation AssessmentUse standardized, valid assessment tools relating to functional activity limitations, impairment due to the stroke, restrictions in role participation, changes in mood and behavior, and environmental restriction  
 Develop individualized rehabilitation plans and update as patient progresses developmentally. This should be done yearly.  
 Determine the appropriate setting for rehabilitation after the initial assessment  
Rehabilitation TeamInclude family members as part of the team
 Other members of the team can include, but not limited to, recreation therapists, educational therapist, and orthotists
General Rehabilitation PrinciplesTo enhance motor control and return sensorimotor function, children should have rehabilitation that is meaningful, engaging, repetitive and progressively adapted, age appropriate, task-specific and goal oriented
 Children should participate in training that encourages use of the affected limb undergoing functional tasks and that mimic daily life activities appropriate for the child’s developmental stage
 Use objective, functional outcome measure before and after to determine benefit for the child
 Use functionally relevant goals determined by the child and the family with the help of a therapist
Arm and Hand RehabilitationInclude range of motion exercises that place the upper limb in a wide range of positions that are safe in the child’s visual field
 Hand and wrist splints can be used and customized for the child along with a plan to monitoring the splints
 Other rehabilitation interventions that can be used for the upper limbs include Functional Electric Stimulation, Mirror Therapy, Botulinum Toxin Type A, Repetitive Transcranial Magnetic Stimulation or Surgical Interventions.  
Lower Limb RehabilitationProvide lower limb range of motion exercises, gait training, and physical activity
 Other rehabilitation therapies that can be used for the lower limbs include Ankle-Foot Orthoses, Botulinum Toxin Type A, or Surgical Interventions  
Devices for Adaption and AssistanceAdaptive devices, like splints and orthoses, can be used
 Special equipment, like wheelchair trays, should be used on an individual basis. Evaluate as the child grows
SchoolContinue to evaluate need for educational and vocational needs during development
 Resume education when the child is ready
 School-aged children should receive educational rehabilitation and support services, along with an individualized educational plan
LeisureOffer treatment that relates to specific play and leisure skills
 Provide information related to leisure skills and adaptive programs in the community

Adult Level Canadian Recommendations: A list of Level A guidelines from the Canadian Stroke Best Practice Recommendations: Stroke Rehabilitation Practice Guidelines, update 2015 is listed below. A more complete list of recommendations can be found online.

Adult Stroke Recommendations Level A
Initial AssessmentPerform initial assessment as soon as possible for all patients admitted to the hospital for acute stroke
 Core Rehabilitation team include physiatrists, other physicians, occupational therapists, physiotherapists, speech-language pathologists, nurses, social workers and dietitians
Rehabilitation Unit CareTreat on a specialized stroke rehabilitation unit
 Allow all patients to engage in inpatient stroke rehabilitation who are ready for rehab and can have their goals changed by rehabilitation
Delivery of RehabilitationPatients should receive rehabilitation as soon as possible and are medically able
 Therapy should be individualized to each patient, appropriate to their level of intensity and duration
 Therapy skills should be incorporated into the patient’s daily life
 Include repetitive and novel tasks that challenge the patient
Outpatient RehabilitationStroke survivors should have access to stroke services even after leaving the hospital or an outpatient service
Early Supported Discharge (ESD)ESD is acceptable when available
 Criteria include mild to moderate disability, ability to participate in rehabilitation after discharge, having medically available care
 Provided by the same team that provided inpatient rehabilitation when possible
Upper Extremity RehabilitationTraining is meaningful and goal oriented to improve motor control and restore sensorimotor function
 Training should simulate everyday tasks
 Functional Electrical Stimulation should be considered that targets the wrist and forearm
 Constraint-induced movement therapy should be considered for certain patients
 Mirror Therapy can be used along with motor therapy
 Virtual Reality can be used along with other therapy
 Strength training is considered for mild to moderate upper extremity function in subacute and chronic recovery phases
 Routine use of splints is not recommended
 Can use botulinum toxin to increase range of motion and decrease pain
 Do not use overhead pulleys for shoulder pain
 Do not move arm beyond 90 degrees of shoulder flexion or abduction in most cases
 Educate staff members, family and the patient about how to handle the arm
Lower ExtremityTone and pain are not impacted by strength training
 Use task and goal training to improve tasks like walking distance
 Treadmill-based gait training can be used
 Electromechanical assisted gait training can be used
 Rhythmic auditory stimulation can be used
 Virtual reality training can be used
 Mental Practice can be used
 Offer balance training
 Trunk training, task specific interventions and force platform biofeedback are effective
 Add specific aerobic training of large muscle groups while monitoring heart rate and blood pressure
 Have a planned transition from structured activity to self-directed activity
 Can use ankle-foot orthoses
 Functional Electrical Stimulation can be used
 Can used botulinum toxin
Dysphagia and NutritionNo Level A recommendations
Visual Field DeficitsNo Level A recommendations
Central PainNo Level A recommendations
Language and CommunicationSupported Conversation techniques should be taught to potential communication partners
Resumption of Life RolesGive targeted therapy for patients struggling with leisure activities

At different disease stages

New onset/acute

  • Management
    • Supportive care, including hydration and management of hypoxia or hypotension. Seizure activity should be treated. Monitor for signs of increased intracranial pressure.
    • Neurology and Pediatric Hematology or a stroke consult service should be involved as early as possible in the acute setting for making timely decisions for thrombolytic therapies for eligible patients.30 In 2010, the National Institute of Neurological disorders and stroke (NINDS) funded the first prospective treatment trial in acute pediatric stroke, the Thrombolysis in Pediatric Stroke (TIPS) trial. This study was defunded because it was unable to recruit enough pediatric ischemic strokes patients.35 The former TIPS sites have continued to identify patients who would have been eligible for TIPS and have treated children with tissue-type plasminogen activator (tPA) using the TIPS protocol. Heparin is not used widely in children with perinatal AIS, although children with severe pro-thrombotic disorders or with cardiac or multiple systemic thrombi may benefit.30
    • Surgical evacuation of hemorrhage is not typically indicated but may be useful in select patients with persistently increased intracranial pressure refractory to medical management.
    • IV thrombolysis within 4.5 hours in >2 years and a PedNIHSS score between 4 and 24. Imaging must show lack of hemorrhage and normal or minimally ischemic parenchyma on CT or acute ischemia on MRI. There also must be arterial occlusion or severe stenosis on CTA or MRA.10
    • IV tPA has been shown to be low risk in children at doses of 0.9 mg/kg with a max dose of 90 mg.36
    • Mechanical thrombectomy is being looked at as treatment for ischemic stroke due to a large vessel occlusion in patients aged 1-18 years.37
  • Markedly low platelet counts and factor deficiencies should be corrected. Vitamin K deficiency may be an issue in areas of the world where vitamin K is not routinely administered to newborns, in infants with biliary atresia, or in babies whose mothers ingested warfarin, phenytoin, or barbiturates during pregnancy.
  • Thorough documentation of deficits will facilitate involvement of appropriate members of the rehabilitation team.

Sub-acute, chronic/stable

  • Secondary prevention and disease management strategies
    • Sickle cell patients with confirmed infarct will require a long-term red blood cell transfusion program for secondary prevention. Those who cannot receive ongoing transfusions may receive hydroxyurea.
    • Even though chronic transfusions carry risk, stopping chronic transfusions lead to increased risk of stroke.38
    • Revascularization is useful in patients with Moyamoya (a congenital syndrome of cerebral arterial malformation).
    • Consult Neurosurgery in determining whether to undergo revascularization in a patient with Moyamoya.33
    • Patients with extra cranial arterial dissection or cardio embolism can be started on heparin therapy and transitioned to warfarin. The duration of therapy is 3-6 months for dissection, and one year or longer for cardio embolic causes (depending on whether the causative lesion can be corrected).
    • Congenital vascular abnormalities should be treated with surgery, endovascular repair, or radiosurgery when possible.
    • Patients may wish to discontinue oral contraceptives, consider other forms of birth control.
    • Oral contraceptives are associated with cerebral sinovenous thrombosis.33
    • In patients with elevated homocysteine levels, diet changes and/or folate, vitamin B6, and vitamin B12 supplementation may be used in attempt to decrease homocysteine.
    • Use of folic acid can decrease risk of sequelae in those with elevated homocysteine levels.33
    • Aspirin and anticoagulation with LMWH is not indicated due to the low recurrent risk for stroke in neonates. Can be used if there is a high risk of recurrent AIS, such as thrombophilia or congenital heart disease.33
    • There is little information about the long-term use of prophylactic therapies such as LMWH in neonates.33 Although recurrent stroke is uncommon in these patients, individuals with prothrombotic conditions plus other risk factors including complex congenital heart disease, dehydration, or prolonged bed rest may have a higher likelihood of recurrent venous and arterial thrombosis, and prophylaxis may be considered in these individuals.33  It is reasonable to supplement folate and B vitamins for children with a methylene tetra hydro-folate reductase (MTHFR) mutation in an effort to normalize homocysteine levels

Rehabilitation strategies

  • Planning a child’s individualized therapy and educational programs may involve multiple team members. Plans must include a thorough assessment of deficits
  • Promote function and safety in a classroom setting through educational rehabilitation and support services. An Individualized Education Plan (IEP) should be made when required. 34
  • Provide information about resources available through school, and how to request a 504 plan or an Individual Education Plan (IEP). This plan should specify educational adaptations, educationally related therapy services, and nursing services to be provided by the school.
  • Orthotics, adaptive equipment, and medical management of spasticity can all be used to facilitate a child’s recovery. 34
  • Parental guilt or blame can be seen, so it is important to consider entire family when starting rehabilitation program.34
  • Goals include education and vocational rehabilitation as well as goals similar to that of an adult.34

Coordination of care

Multidisciplinary teams remain the standard of care for pediatric stroke patients.

In acute care setting: The critical care team, neurology, hematology, trauma service, neurosurgery, care co-ordination, and physiatry may be involved.

In Rehabilitation setting: physiatry, pediatrics, physical therapy, occupational therapy, speech therapy, neuropsychology, dietician, child life therapies, recreational therapies, care-coordinators, social worker, nursing staff, and services that had evaluated the patient during acute management (to follow-up on any pending health concerns) may be involved.

Patient & family education

Most sources do indicate cautious optimism is warranted; a good balance of honesty about probable long-term deficits but also overall strong potential for recovery that is possible should be provided.

The Children’s Hemiplegia and Stroke Association (http://www.chasa.org/) is an excellent starting point for families to meet others with similar experiences, learn about stroke rehabilitation, and find events and activities for children who have had a stroke.

Emerging/unique interventions

Several validated measures have been used to document outcomes, but not all are specific to pediatric stroke. The Pediatric Stroke Outcomes Measure, Pediatric Stroke Recurrence and Recovery Questionnaire, and the PedNIHSS were developed specifically for this population.17

Translation into practice: practice “pearls”/performance improvement in practice (PIPs)/changes in clinical practice behaviors and skills

Remember to keep stroke in the differential diagnosis for children with neurologic complaints, headache, or vomiting. Misdiagnosis or delayed diagnosis is common.18

Inpatient Rehabilitation has been shown to significantly improve functional outcomes, with hemorrhagic strokes having better outcomes than ischemic strokes.39

Children who had a stroke were found to have worse academic achievement in the future, specifically in mathematics.40  It is important to have a neuropsychologist screen these children because they may have difficulties with higher level learning that are overlooked early on.41  It is recommended that children receive an individualized education plan to meet the needs of that child. 34

Children were more likely to regain function in a previously learned domain than achieve a new skill. Thus, younger age is a risk factor which may limit progress in ADL independence.9

If a child develops new deficits, it is important to consider a recurrent stroke.9

A recent study of Cerebral Palsy patients suggest that children are able to choose functional and developmentally appropriate goals for themselves. This study suggest children should be able to define their own goals in rehabilitation and may be useful when treating pediatric stroke patients.42

Cutting Edge/ Emerging and Unique Concepts and Practice

Robotic therapies to improve upper extremity function have been tested in adult stroke patients and in children with cerebral palsy. Expansion to the pediatric stroke population is a logical next step.30

Newer robotic therapies like virtual reality and electromechanical assisted gait training, can be useful in children. 34

Early studies have shown noninvasive brain stimulation with other therapies, like CIMT, may lead to improved upper extremity outcomes.4

Transcranial magnetic stimulation (TMS) and transcranial direct-current stimulation (tDCS) are being shown to be safe in the pediatric stroke population.43

A recent review showed most effective methods are CIMT, forced use therapy, repetitive transcranial magnetic stimulation, functional electrical stimulation, and robotics.44

Implanted brain-computer interface is an emerging technology in adults and a recent pilot study showed benefit in improving limb function.45

Other interventions that are being examined in the adult populations include stem-cell based treatment and the use of pharmacologic interventions, like Fluoxetine (Pediatric Stroke: Unique implications of the immature brain on injury and recovery).4

Gaps in the Evidence- Based Knowledge

Extensive pediatric research in the field of pediatric stroke is lacking due to relative low incidence of stroke in pediatric population. Some of the reasons these reasons include the difference in clinical presentation based on symptoms and age, making the diagnosis more challenging, the various risk factors that can lead to pediatric stroke, and the low prevalence making it difficult to perform large studies.10, 35

Mechanical thrombectomy reports have some inconsistency and may not be as beneficial as some reports imply.46

The gene ADAMTS encodes for parts of the extracellular matrix and recent evidence suggests that some of the genes, like ADAMTS12, can lead to increased risk of pediatric stroke.47Other genes that may affect pediatric stroke include: ANCC6 and COL4A1. These studies suggest that there are a number of genetic variances that can increase likelihood of pediatric stroke.48

Rehabilitation has focused mostly on the upper limbs, while fewer focus on the lower limbs or cognitive impairment.44

Early studies showed Pediatric Stroke is an infrequent, but important, complication of COVID-19. 49 Case reports have described pediatric strokes 3-4 weeks after a COVID-19 infection, but the overall effect is unknown.50


  1. Advances in pediatrics in Pediatric stroke: past, present and future. Neil Friedman MBChB. DOI 10:1016/j.yapad.2009.08.003.
  2. Khalaf A, Iv M, Fullerton H, Wintermark M. Pediatric Stroke Imaging. Pediatr Neurol. 2018 Sep;86:5-18. doi: 10.1016/j.pediatrneurol.2018.05.008. Epub 2018 Jul 9. PMID: 30122281; PMCID: PMC6215731.
  3. Raju TN, Nelson KB, Ferriero D, Lynch JK; NICHD-NINDS Perinatal Stroke Workshop Participants. Ischemic perinatal stroke: summary of a workshop sponsored by the National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke. Pediatrics. 2007 Sep;120(3):609-16. doi: 10.1542/peds.2007-0336. PMID: 17766535.
  4. Malone LA, Felling RJ. Pediatric Stroke: Unique Implications of the Immature Brain on Injury and Recovery. Pediatr Neurol. 2020 Jan;102:3-9. doi: 10.1016/j.pediatrneurol.2019.06.016. Epub 2019 Jul 3. PMID: 31371122; PMCID: PMC6959511.
  5. Stroke in infancy: a convergence of causes. GABRIELLE DEVEBER doi: 10.1111/dmcn.12296
  6. Lo W, Stephens J, Fernandez S. Pediatric stroke in the United States and the impact of risk factors. J Child Neurol. 2009 Feb;24(2):194-203. doi: 10.1177/0883073808322665. Erratum in: J Child Neurol. 2010 Sep;25(9):1171. PMID: 19182157; PMCID: PMC3720133.
  7. Ishihara C, Sawada K, Tateno A. Bilateral basal ganglia infarction after mild head trauma. Pediatr Int 2009; 51: 829–31.
  8. Mallick AA, Ganesan V, Kirkham FJ, Fallon P, Hedderly T, McShane T, Parker AP, Wassmer E, Wraige E, Amin S, Edwards HB, Tilling K, O’Callaghan FJ. Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study. Lancet Neurol. 2014 Jan;13(1):35-43. doi: 10.1016/S1474-4422(13)70290-4. Epub 2013 Dec 2. PMID: 24304598/.
  9. Hurvitz E, Beale L, Ried S, Nelson V. Functional outcome of paediatric stroke survivors. Pediatr Rehabil. 1999;3(2):43-51.
  10. Rajani NK, Pearce K, Campion T, Salpietro V, Planells M, Chong W, Patankar T, Mankad K. Pediatric stroke: current diagnostic and management challenges. Quant Imaging Med Surg. 2018 Nov;8(10):984-991. doi: 10.21037/qims.2018.11.09. PMID: 30598876; PMCID: PMC6288056.
  11. Meyer-Heim AD, Boltshauser E. Spontaneous intracranial haemorrhage in children: aetiology, presentation and outcome. Brain Dev. 2003 Sep;25(6):416-21. doi: 10.1016/s0387-7604(03)00029-9. PMID: 12907276.
  12. Jordan, L. C., & Hillis, A. E. (2007). Hemorrhagic stroke in children. Pediatric neurology36(2), 73–80. https://doi.org/10.1016/j.pediatrneurol.2006.09.017
  13. Lee MT, Piomelli S, Granger S, et al. Stroke prevention trial in sickle cell anemia (STOP): extended follow up and final results. Blood. 2006; 08(3): 847-852.
  14. Fullerton HJ, Hills NK, Elkind MS, Dowling MM, Wintermark M, Glaser CA, Tan M, Rivkin MJ, Titomanlio L, Barkovich AJ, deVeber GA; VIPS Investigators. Infection, vaccination, and childhood arterial ischemic stroke: Results of the VIPS study. Neurology. 2015 Oct 27;85(17):1459-66. doi: 10.1212/WNL.0000000000002065. Epub 2015 Sep 30. PMID: 26423434; PMCID: PMC4631070.
  15. Billinghurst LL, Beslow LA, Abend NS, Uohara M, Jastrzab L, Licht DJ, Ichord RN. Incidence and predictors of epilepsy after pediatric arterial ischemic stroke. Neurology. 2017 Feb 14;88(7):630-637. doi: 10.1212/WNL.0000000000003603. Epub 2017 Jan 13. PMID: 28087825; PMCID: PMC5317388.
  16. Rafay MF, Pontigon AM, Chiang J, Adams M, Jarvis DA, Silver F, Macgregor D, Deveber GA. Delay to diagnosis in acute pediatric arterial ischemic stroke. Stroke. 2009 Jan;40(1):58-64. doi: 10.1161/STROKEAHA.108.519066. Epub 2008 Sep 18. PMID: 18802206.
  17. Royal College of Pediatrics and Child Health. Full recommendations for childhood stroke. 2017. https://www.rcpch.ac.uk/sites/default/files/2019-04/20160314%20Full%20Recommendations%2008.04.19.pdf
  18. Bektaş G, Kipoğlu O, Pembegül Yıldız E, Aydınlı N, Çalışkan M, Özmen M, Sencer S. Epileptic spasm and other forms of epilepsy in presumed perinatal arterial ischemic stroke in Turkey after more than 10 years follow-up: A single centre study. Brain Dev. 2019 Sep;41(8):699-705. doi: 10.1016/j.braindev.2019.04.004. Epub 2019 Apr 16. PMID: 31003833.
  19. Leong A, Floer A, Kirton A, Mineyko A. Head circumference trajectory in children with perinatal stroke. J Child Neurol. 2021 Mar 8:883073821996103. doi: 10.1177/0883073821996103. Epub ahead of print. PMID: 33683972.
  20. Sherman V, Martino R, Bhathal I, DeVeber MG, Dlamini N, MacGregor D, Pulcine E, Beal DS, Thorpe KE, Moharir M. Swallowing, Oral Motor, Motor Speech, and Language Impairments Following Acute Pediatric Ischemic Stroke. Stroke. 2021 Mar 1:STROKEAHA120031893. doi: 10.1161/STROKEAHA.120.031893. Epub ahead of print. PMID: 33641384.
  21. Slim M, Westmacott R, Toutounji S, Singh J, Narang I, Weiss S, Krishnan P, Grbac E, Surmava AM, Andres K, MacGregor D, deVeber G, Moharir M, Dlamini N. Obstructive sleep apnea syndrome and neuropsychological function in pediatric stroke. Eur J Paediatr Neurol. 2020 Mar;25:82-89. doi: 10.1016/j.ejpn.2019.11.006. Epub 2019 Nov 21. PMID: 31787553.
  22. Ichord, R. N., Bastian, R., Abraham, L., Askalan, R., Benedict, S., Bernard, T. J., Beslow, L., Deveber, G., Dowling, M., Friedman, N., Fullerton, H., Jordan, L., Kan, L., Kirton, A., Amlie-Lefond, C., Licht, D., Lo, W., McClure, C., Pavlakis, S., Smith, S. E., … Jawad, A. F. (2011). Interrater reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a multicenter study. Stroke42(3), 613–617. https://doi.org/10.1161/STROKEAHA.110.607192
  23. Greenham M, Gordon A, Anderson V, Mackay MT. Outcome in Childhood Stroke. Stroke. 2016 Apr;47(4):1159-64. doi: 10.1161/STROKEAHA.115.011622. Epub 2016 Mar 8. PMID: 26956257.
  24. Lo W, Gordon AL, Hajek C, Gomes A, Greenham M, Anderson V, Yeates KO, Mackay MT. Pediatric stroke outcome measure: predictor of multiple impairments in childhood stroke. J Child Neurol. 2014 Nov;29(11):1524-30. doi: 10.1177/0883073813503186. Epub 2013 Oct 25. PMID: 24163399.
  25. Cooper AN, Anderson V, Hearps S, Greenham M, Hunt RW, Mackay MT, Monagle P, Gordon AL. The Pediatric Stroke Outcome Measure: A predictor of outcome following arterial ischemic stroke. Neurology. 2018 Jan 30;90(5):e365-e372. doi: 10.1212/WNL.0000000000004906. PMID: 29378928.
  26. Donahue MJ, Dlamini N, Bhatia A, Jordan LC. Neuroimaging Advances in Pediatric Stroke. Stroke. 2019 Feb;50(2):240-248. doi: 10.1161/STROKEAHA.118.020478. PMID: 30661496; PMCID: PMC6450544.
  27. Lee S, Mirsky DM, Beslow LA, Amlie-Lefond C, Danehy AR, Lehman L, Stence NV, Vossough A, Wintermark M, Rivkin MJ; International Paediatric Stroke Study Neuroimaging Consortium and the Paediatric Stroke Neuroimaging Consortium. Pathways for Neuroimaging of Neonatal Stroke. Pediatr Neurol. 2017 Apr;69:37-48. doi: 10.1016/j.pediatrneurol.2016.12.008. Epub 2017 Jan 26. PMID: 28262550.
  28. Bigi S, Fischer U, Wehrli E, et al. Acute ischemic stroke in children versus young adults. Ann Neurol. 2011;70(2):245-254.
  29. Jordan LC, Kleinman JT, Hillis AE. Intracerebral hemorrhage volume predicts poor neurologic outcome in children. Stroke. 2009;40(5):1666-1671.
  30. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines Paul Monagle , MBBS , MD , FCCP ; Anthony K. C. Chan , MBBS ; Neil A. Goldenberg , MD , PhD ; Rebecca N. Ichord , MD ; Janna M. Journeycake , MD , MSCS ; Ulrike Nowak-Göttl , MD ; and Sara K. Vesely , PhD.
  31. Management of Stroke in Infants and Children A Scientific Statement From a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young E. Steve Roach, MD, FAHA, Chair; Meredith R. Golomb, MD, MSc; Robert Adams, MD, MS, FAHA; Jose Biller, MD, FAHA; Stephen Daniels, MD, PhD, FAHA; Gabrielle deVeber, MD; Donna Ferriero, MD; Blaise V. Jones, MD; Fenella J. Kirkham, MB, MD; R. Michael Scott, MD, FAHA; Edward R. Smith, MD.
  32. Lehman LL, Maletsky K, Beaute J, Rakesh K, Kapur K, Rivkin MJ, Mrakotsky C. Prevalence of Symptoms of Anxiety, Depression, and Post-traumatic Stress Disorder in Parents and Children Following Pediatric Stroke. J Child Neurol. 2020 Jun;35(7):472-479. doi: 10.1177/0883073820909617. Epub 2020 Mar 23. PMID: 32202201.
  33. Ferriero DM, Fullerton HJ, Bernard TJ, Billinghurst L, Daniels SR, DeBaun MR, deVeber G, Ichord RN, Jordan LC, Massicotte P, Meldau J, Roach ES, Smith ER; American Heart Association Stroke Council and Council on Cardiovascular and Stroke Nursing. Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke. 2019 Mar;50(3):e51-e96. doi: 10.1161/STR.0000000000000183. PMID: 30686119.
  34. Hebert D, Lindsay MP, McIntyre A, Kirton A, Rumney PG, Bagg S, Bayley M, Dowlatshahi D, Dukelow S, Garnhum M, Glasser E, Halabi ML, Kang E, MacKay-Lyons M, Martino R, Rochette A, Rowe S, Salbach N, Semenko B, Stack B, Swinton L, Weber V, Mayer M, Verrilli S, DeVeber G, Andersen J, Barlow K, Cassidy C, Dilenge ME, Fehlings D, Hung R, Iruthayarajah J, Lenz L, Majnemer A, Purtzki J, Rafay M, Sonnenberg LK, Townley A, Janzen S, Foley N, Teasell R. Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update 2015. Int J Stroke. 2016 Jun;11(4):459-84. doi: 10.1177/1747493016643553. Epub 2016 Apr 14. PMID: 27079654.
  35. Rivkin MJ, deVeber G, Ichord RN, Kirton A, Chan AK, Hovinga CA, Gill JC, Szabo A, Hill MD, Scholz K, Amlie-Lefond C. Thrombolysis in pediatric stroke study. Stroke. 2015 Mar;46(3):880-5. doi: 10.1161/STROKEAHA.114.008210. Epub 2015 Jan 22. PMID: 25613306; PMCID: PMC4342311.
  36. Amlie-Lefond C, Shaw DWW, Cooper A, Wainwright MS, Kirton A, Felling RJ, Abraham MG, Mackay MT, Dowling MM, Torres M, Rivkin MJ, Grabowski EF, Lee S, Kurz JE, McMillan HJ, Barry D, Lee-Eng J, Ichord RN. Risk of Intracranial Hemorrhage Following Intravenous tPA (Tissue-Type Plasminogen Activator) for Acute Stroke Is Low in Children. Stroke. 2020 Feb;51(2):542-548. doi: 10.1161/STROKEAHA.119.027225. Epub 2019 Dec 17. Erratum in: Stroke. 2020 Feb;51(2):e46. PMID: 31842706.
  37. Bhatia K, Kortman H, Blair C, Parker G, Brunacci D, Ang T, Worthington J, Muthusami P, Shoirah H, Mocco J, Krings T. Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series. J Neurosurg Pediatr. 2019 Aug 9:1-14. doi: 10.3171/2019.5.PEDS19126. Epub ahead of print. PMID: 31398697.
  38. Adams RJ, Brambilla D; Optimizing Primary Stroke Prevention in Sickle Cell Anemia (STOP 2) Trial Investigators. Discontinuing prophylactic transfusions used to prevent stroke in sickle cell disease. N Engl J Med. 2005 Dec 29;353(26):2769-78. doi: 10.1056/NEJMoa050460. PMID: 16382063.
  39. Ullah S, Bin Ayaz S, Zaheer Qureshi A, Samir Tantawy S, Fe Flandez M. Characteristics and functional outcomes of pediatric stroke survivors at a rehabilitation unit in Saudi Arabia. J Clin Neurosci. 2020 Nov;81:403-408. doi: 10.1016/j.jocn.2020.10.014. Epub 2020 Oct 23. PMID: 33222951.
  40. Deotto A, Westmacott R, Fuentes A, deVeber G, Desrocher M. Does stroke impair academic achievement in children? The role of metacognition in math and spelling outcomes following pediatric stroke. J Clin Exp Neuropsychol. 2019 Apr;41(3):257-269. doi: 10.1080/13803395.2018.1533528. Epub 2018 Oct 23. PMID: 30350753.
  41. Peterson RK, Williams TS, McDonald KP, Dlamini N, Westmacott R. Cognitive and Academic Outcomes Following Childhood Cortical Stroke. J Child Neurol. 2019 Dec;34(14):897-906. doi: 10.1177/0883073819866609. Epub 2019 Aug 12. PMID: 31402724.
  42. Metzler MJ, Haspels E, Brunton L, Andersen J, Pritchard L, Herrero M, Hodge J, Kirton A. Goals of children with unilateral cerebral palsy in a brain stimulation arm rehabilitation trial. Dev Med Child Neurol. 2020 Dec 24. doi: 10.1111/dmcn.14763. Epub ahead of print. PMID: 33368181.
  43. Zewdie E, Ciechanski P, Kuo HC, Giuffre A, Kahl C, King R, Cole L, Godfrey H, Seeger T, Swansburg R, Damji O, Rajapakse T, Hodge J, Nelson S, Selby B, Gan L, Jadavji Z, Larson JR, MacMaster F, Yang JF, Barlow K, Gorassini M, Brunton K, Kirton A. Safety and tolerability of transcranial magnetic and direct current stimulation in children: Prospective single center evidence from 3.5 million stimulations. Brain Stimul. 2020 May-Jun;13(3):565-575. doi: 10.1016/j.brs.2019.12.025. Epub 2019 Dec 30. PMID: 32289678.
  44. Mirkowski M, McIntyre A, Faltynek P, Sequeira N, Cassidy C, Teasell R. Nonpharmacological rehabilitation interventions for motor and cognitive outcomes following pediatric stroke: a systematic review. Eur J Pediatr. 2019 Apr;178(4):433-454. doi: 10.1007/s00431-019-03350-7. Epub 2019 Feb 27. PMID: 30810821.
  45. Serruya MD, Napoli A, Sattertnwaite N, Kardine J, McCoy J, Grampurohit N, Talekar K, Middleton D, Mohamed F, Kogan M, Sharan A, Wu C, Rosenwasser R. Neuromotor Prosthetic to Treat Stroke-Related Paresis. 2021 Feb. doi: 10.1101/2021.02.03.21250720.
  46. Barry M, Barry D, Kansagra AP, Hallam D, Abraham M, Amlie-Lefond C; Thrombolysis in Pediatric Stroke (TIPSTER) Investigators. Higher-Quality Data Collection Is Critical to Establish the Safety and Efficacy of Pediatric Mechanical Thrombectomy. Stroke. 2021 Mar 15:STROKEAHA120032009. doi: 10.1161/STROKEAHA.120.032009. Epub ahead of print. PMID: 33719517.
  47. Witten A, Rühle F, de Witt M, Barysenka A, Stach M, Junker R, Nowak-Göttl U, Stoll M. ADAMTS12, a new candidate gene for pediatric stroke. PLoS One. 2020 Aug 20;15(8):e0237928. doi: 10.1371/journal.pone.0237928. PMID: 32817637; PMCID: PMC7446847.
  48. Grossi A, Severino M, Rusmini M, Tortora D, Ramenghi LA, Cama A, Rossi A, Di Rocco M, Ceccherini I, Bertamino M; Gaslini Stroke Study Group. Targeted re-sequencing in pediatric and perinatal stroke. Eur J Med Genet. 2020 Nov;63(11):104030. doi: 10.1016/j.ejmg.2020.104030. Epub 2020 Aug 18. PMID: 32818659.
  49. Beslow LA, Linds AB, Fox CK, Kossorotoff M, Zuñiga Zambrano YC, Hernández-Chávez M, Hassanein SMA, Byrne S, Lim M, Maduaka N, Zafeiriou D, Dowling MM, Felling RJ, Rafay MF, Lehman LL, Noetzel MJ, Bernard TJ, Dlamini N; International Pediatric Stroke Study Group. Pediatric Ischemic Stroke: An Infrequent Complication of SARS-CoV-2. Ann Neurol. 2020 Dec 17. doi: 10.1002/ana.25991. Epub ahead of print. PMID: 33332607.
  50. Appavu B, Deng D, Morgan Dowling M, et al. Arteritis and large vessel occlusive strokes in children following COVID-19 infection. Pediatrics. 2020; doi: 10.1542/peds.2020- 023440

Original Version of the Topic

Edward Hurvitz, MD and Alecia Daunter, MD. Pediatric stroke. Published9/20/2013

Previous Revision(s) of the Topic

Rajashree Srinivasan, MD and Saylee Dhamdhere MD, UTSW. Pediatric stroke. Published 8/8/2017

Author Disclosures

Sathya Vadivelu, DO
Nothing to Disclose

Joshua Kaseff, MS
Nothing to Disclose