A stroke, sometimes called a brain attack, occurs when something blocks blood supply to part of the brain or when a blood vessel in the brain bursts.

In either case, parts of the brain become damaged or die. A stroke can cause lasting brain damage, long-term disability, or even death.

What happens in the brain during a stroke?

The brain controls our movements, stores our memories, and is the source of our thoughts, emotions, and language. The brain also controls many functions of the body, like breathing and digestion.

To work properly, your brain needs oxygen. Your arteries deliver oxygen-rich blood to all parts of your brain. If something happens to block the flow of blood, brain cells start to die within minutes, because they can’t get oxygen. This causes a stroke.

Quick treatment is critical for stroke

A stroke is a serious medical condition that requires emergency care. Act F.A.S.T. Call 9-1-1 right away if you or someone you are with shows any signs of a stroke.

Time lost is brain lost. Every minute counts.

What are the types of stroke?

There are two types of stroke:

• Ischemic stroke.
• Hemorrhagic stroke.

A transient ischemic attack (TIA) is sometimes called a “mini-stroke.” It is different from the major types of stroke, because blood flow to the brain is blocked for only a short time—usually no more than 5 minutes.

Ischemic stroke

Most strokes are ischemic strokes. An ischemic stroke occurs when blood clots or other particles block the blood vessels to the brain.

Fatty deposits called plaque can also cause blockages by building up in the blood vessels.

Hemorrhagic stroke

A hemorrhagic stroke happens when an artery in the brain leaks blood or ruptures (breaks open). The leaked blood puts too much pressure on brain cells, which damages them.

High blood pressure and aneurysms—balloon-like bulges in an artery that can stretch and burst—are examples of conditions that can cause a hemorrhagic stroke.

Transient ischemic attack (TIA or “mini-stroke”)

TIAs are sometimes known as “warning strokes.” It is important to know that

• A TIA is a warning sign of a future stroke.
• A TIA is a medical emergency, just like a major stroke.
• Strokes and TIAs require emergency care. Call 9-1-1 right away if you feel signs of a stroke or see symptoms in someone around you.
• There is no way to know in the beginning whether symptoms are from a TIA or from a major type of stroke.
• Like ischemic strokes, blood clots often cause TIAs.
• More than a third of people who have a TIA and don’t get treatment have a major stroke within 1 year. As many as 10% to 15% of people will have a major stroke within 3 months of a TIA.

Recognizing and treating TIAs can lower the risk of a major stroke. If you have a TIA, your health care team can find the cause and take steps to prevent a major stroke.

Many parents worry that they caused their child’s stroke. This isn’t the case.

Perinatal stroke (before or shortly after birth)

• Pregnancy complications.
• Difficulties during birth.
• Infections.
• Blood clotting disorders.
• Heart problems increase the risk of stroke.

Childhood stroke (one month old to 18 years old)

Problems with the brain’s blood vessels can increase the risk of stroke.

• Vasculitis can cause a blood vessel to become narrow or weak.
• Focal Cerebral Arteriopathy (FCA) can cause blood vessels to become narrow.
• Head or neck trauma can cause a blood clot to form, or cause blood to leak from a blood vessel.
• Moyamoya disease can cause blood vessels to become narrow and blocked.
• An arteriovenous malformation (AVM) is a tangled mass of blood vessels in the brain that can burst.
• An aneurysm is a weak or thin spot on an artery wall that can burst.
• A cavernous malformation is a cluster of abnormal blood vessels in the brain that can leak.

Problems with the heart or heart surgery can increase the risk of stroke. Blood clotting or other disorders can also increase the risk.

Babies

• Seizures.
• Extreme sleepiness.

In babies, there may not be signs while the stroke is happening. You may notice changes in the way your baby develops over time, such as a tendency to use only one side of their body.

Toddlers, children and teenagers

• Weakness or numbness in the face, arm or leg, especially on one side.
• Difficulty speaking, understanding, reading or writing.
• Trouble seeing or loss of vision.
• Dizziness, loss of balance or poor coordination.
• Severe or unusual headaches, nausea or vomiting.
• Difficulty swallowing, including drooling.
• Seizures with weakness that doesn’t improve.
• Changes in behaviour and difficulty concentrating.
• Stroke can sometimes cause children to collapse.

If you notice any of these signs, call 911 immediately. Even if you aren’t sure, or the signs only last for a few minutes, call 911.

If your child has had a stroke, talk with your child’s doctors about the signs you need to be aware of. Pass this information on to family, friends, childcare, kindergarten and school.

The effects of stroke are different for every child. How the stroke affects your child depends on the area of their brain that was injured and how badly.

Your child’s brain controls everything they think, feel, say and do. Stroke can affect:

• Walking and moving.
• Swallowing.
• Speaking, understanding, reading, writing.
• Thinking, memory, judgement.
• Personality, behaviour, emotions.
• Vision, touch, taste, smell.
• Toileting.

Children can experience pain and fatigue after a stroke. Recurrent seizures or fits (epilepsy) can develop.

Effects may be minor or they may be more serious. Effects may become more obvious as your child develops. Effects can also improve over time.

Tests to diagnose stroke include the following:

• Computed tomography (CT) uses X-rays to take clear, detailed pictures of your brain. It is often done right after a stroke is suspected. A brain CT scan can show if there is bleeding in the brain or damage to the brain cells from a stroke.
• Magnetic resonance imaging (MRI) uses magnets and radio waves to create pictures of your brain. An MRI may be used instead of—or in addition to—a CT scan to diagnose a stroke. This test can detect changes in brain tissue and damage to brain cells.
• Other imaging tests to look for narrowed blood vessels in the neck or an aneurysm or tangled blood vessels in the brain.

Your doctor may also order the following blood or heart tests.

• Blood tests. Your doctor may test the blood and platelet count and glucose (sugar) levels in your blood to make sure they are stable and to see if a certain medicine can treat your stroke. Your doctor may also do blood tests to see how well your blood is clotting and to look for muscle damage.
• Electrocardiogram (EKG). An EKG can help detect heart problems that may have led to a stroke. For example, this test can help diagnose atrial fibrillation or a previous heart attack.
• Lumbar puncture (also called a spinal tap), if the imaging scan does not detect any bleeding in the brain but your doctor still thinks you may have had a hemorrhagic stroke. The doctor will use a needle to collect fluid from around your spine. The fluid will be tested for substances from broken-down blood cells.

Treatment is given to minimise the injury to the brain and the risk of another stroke. Your child’s doctor will talk with you about whether treatment is appropriate and safe for your child.

Ischaemic stroke. There are early treatments for stroke that can unblock the artery so the blood can get through. Surgery may be needed to relieve the pressure caused by swelling in the brain.

Haemorrhagic stroke. Surgery may be needed to:

• Repair the damaged artery and stop the bleeding.
• Relieve the pressure caused by the buildup of blood.
• Seal or remove an aneurysm or an arteriovenous malformation.

After a stroke, children need access to therapy to support their development and recovery. Therapies may include physiotherapy, speech therapy, occupational therapy and psychology. Therapy should begin as soon as possible after your child’s stroke.

Early intervention is for babies and very young children. Rehabilitation is for older children.

If your child is in hospital after their stroke, therapy will begin there. After that, therapy options depend on what’s best for your child and what’s available in your area.