May is a month dedicated to learning about strokes and to advocate for those touched by this sudden and serious medical condition. Since strokes can happen even in kids the WVU Medicine Children’s Neuroscience Center is building a comprehensive stroke and pediatric neurocritical care program for treating stroke in children and infants in West Virginia and the Appalachia region.

Many people are surprised to learn children can have strokes, but, unfortunately, most realize this only after a stroke happens to their child. About 6 out of 100,000 children have strokes every year, and stroke is among the top 12 causes of deaths in those aged 1-19 years.

Strokes are caused by a blockage in the blood vessels that prevent oxygen and nutrients from getting to a part of the brain. This can either be due to a clot, or the blood vessel itself can break, allowing blood to enter the brain that then causes a portion of the brain to be damaged and/or die. There are many types of strokes, and each of these has a different cause requiring individualized treatment.

Whenever there is concern a child may be having a stroke, our standard stroke protocol is immediately activated. The WVU Health System has a network of 31 hospital and telestroke sites so any patient who needs care can be diagnosed and treated immediately.”

A highly trained and specialized neurologic team is always on call and is contacted immediately. Our Neurology On-call Team will swiftly get an MRI and/or blood vessel test of the brain to direct care and treatment. While the imaging is happening, the stroke neurologist is actively reviewing the pictures in real time and, depending on what kind of stroke has occurred, treatment progresses immediately because “Time Is Brain!”

The team at WVU Medicine Children’s has access to clot-busting medication, which can be given right away, and getting this medication to the child as soon as possible is very important. If there is a big clot stuck in the blood vessel, our neuro-interventional doctor can emergently remove it using special wires and catheters. Our neurosurgeons are also on stand-by should they need to take the patient to the operating room if the stroke has caused a lot of bleeding or swelling.

As soon as the stroke has been treated, the Team begins to look for what caused the stroke. At WVU Medicine Children’s, we have all the latest technologies and can perform specialized imaging to evaluate every aspect of the brain and its vessels. This imaging allows us to make the right decisions in providing the right treatment at the right time.

We are also able to check for any reason the blood would clot more quickly than in another child, such as an unknown clotting disorder or an infection. Our Neurology Stroke Team uses all these pieces of information to design the best treatment to move forward while keeping the family involved in the care of their child.

The Team tasked with treating neurocritically ill children consists of specially trained and highly dedicated neuroradiologists, a neurointerventionalist, hematologists, and neurologists. The images and other results are reviewed, and a discussion is held regarding how to safely move forward with further evaluation and treatment.

Once the comprehensive work up is complete and the right treatment has been started, these children are then evaluated by our rehabilitation doctors to see if they would benefit from physical, occupational, and speech therapies. It is also determined whether the patient needs intensive inpatient rehabilitation or whether these therapies can take place at home.

Once discharged home, these children will follow up in one of our multidisciplinary clinics, where we speak with the families about how to help their child continue to recover and to prevent additional strokes, as well as improve their neurological and cognitive outcomes.

Our Stroke Team has successfully taken care of patients with all types of strokes. We have had newborn babies with strokes, patients in the Cardiac ICU who have had strokes related to their heart disease, children with underlying medical diseases that predispose them to have seizures and strokes, and children who have had strokes for unknown reasons.

The rapidly expanding WVU Medicine Children’s Neuroscience Center is eager to treat these children and continues to progress toward a better understanding of pediatric stroke and their neurocritical care needs to allow better outcomes for our precious and complex patients.