Comprehensive Stroke Care for Children at MedStar Health
Our Comprehensive Stroke Center in the Washington, D.C., area provides specialized pediatric stroke care. Our physicians are nationally renowned for their expertise.
Many people are unaware that children can suffer strokes. Unfortunately, this realization often comes only after a child has been affected. Pediatric stroke is more common than expected and is the sixth leading cause of death in children. It affects approximately 25 in 100,000 newborns and 12 in 100,000 individuals under 18 years of age. Annually, about 6 out of 100,000 children experience strokes, making it one of the top 12 causes of death among those aged 1–19 years.
Strokes occur when blood flow to a part of the brain is interrupted, either due to a clot blocking a vessel or a vessel rupturing and bleeding into the brain. Both scenarios can cause brain damage or cell death. Since strokes vary in type and cause, each case requires a personalized treatment approach.
MedStar Georgetown University Hospital is one of few Comprehensive Stroke Centers in the DMV region accredited by The Joint Commission. Our pediatric stroke team is available around the clock and uses advanced treatment protocols to minimize brain damage and improve outcomes. When a stroke call is activated and there is concern that a child may be having a stroke, the highly trained and specialized pediatric neurologic and critical care teams are always on call and are contacted immediately.
Rapid Evaluation and Diagnosis
Early diagnosis is critical in pediatric stroke care. Delayed treatment can result in long-term disability or recurrent strokes. When a stroke is suspected, our team immediately performs advanced brain imaging, including MRI and blood vessel studies, to confirm the diagnosis and guide urgent treatment.
A pediatric stroke neurologist reviews the imaging in real time to determine the type of stroke and initiate appropriate therapy. Our facility is equipped with the latest technology to assess brain function and blood flow, allowing us to make timely and informed treatment decisions.
Immediate and Specialized Treatment
Once diagnosed, treatment begins without delay. If the stroke is caused by a clot, our team can administer clot-dissolving medications promptly. In cases where a large clot blocks a blood vessel, our neuro-interventional specialists can remove it using minimally invasive techniques.
We also conduct thorough evaluations to uncover any underlying causes, such as clotting disorders or infections, that may increase the risk of stroke. This information helps us tailor a treatment plan specific to the child’s needs while involving the family in every step of the care process.
Multidisciplinary Team Approach
Our team comprises pediatric neurologists, neurointerventionalists, neuroradiologists, intensivists, hematologists, and rehabilitation specialists. Together, they review all diagnostic findings and collaborate on a safe and effective treatment strategy.
After the acute phase, children are evaluated for rehabilitation needs. Depending on the situation, physical, occupational, and speech therapy may be provided either in an inpatient setting or at home.
Long-Term Care and Follow-Up
Following hospital discharge, children continue care through our multidisciplinary Pediatric Stroke and Spasticity Clinic. Here, we work closely with families to support recovery, prevent future strokes, and improve neurological and cognitive development.
We have successfully treated infants and children with a wide range of stroke causes—from newborns and children with predisposing conditions to those with strokes of unknown origin.
Vasculopathies in Pediatric Stroke
Stroke in children can be caused by problems with the vessels in the brain or neck (vasculopathy). The most common vasculopathies in children are conditions affecting the arteries - arteriopathies (such as focal cerebral arteriopathy, vasculopathy associated with Sickle Cell Disease, and moyamoya disease) and inflammation in the vessels - vasculitis. In addition, infections, systemic inflammatory diseases (such as lupus), genetic conditions and trauma can lead to these vasculopathies, which can result in narrowed blood vessels (stenosis) or damage, increasing the risk of both initial and recurrent strokes.
Moyamoya disease is a condition characterized by progressive narrowing of intracranial arteries, particularly the internal carotid artery. In some instances, this condition can present with transient neurologic symptoms (weakness, headache or even seizures). It can be associated to other genetic conditions, or specific gene mutations.
Vasculopathies associated with Sickle Cell Disease (SCD) can lead to progressive stenosis and strokes. Sometimes these strokes can be silent, but over time they severely affect the child’s neurological function. Focal Cerebral Arteriopathy (FCA) is one of the leading causes of stroke in children, characterized by a specific, progressive lesion in a cerebral artery; it is typically diagnosed in a previously healthy child. There is increasing evidence that FCA is an inflammatory process, either infectious or postinfectious, leading narrowing of the affected artery and formation of thrombus on the inflamed arterial lining (endothelium).
Childhood vasculitis is a challenging and complex group of conditions that can be part of an underlying systemic disease requiring integrated care from multiple subspecialties including rheumatology, neurology, cardiology, dermatology and neuroradiology. Vasculitis is an inflammation in the blood vessel wall. The location and severity of vessels involvement, the size of the affected vessels, and the underlying pathology determine the severity and treatment options.
Diagnosis and Treatment
Diagnosis of vasculopathies involve neuroimaging techniques such as MRI and CT scan as well as modalities to specifically visualize the vessels details (MRA and sometimes angiography).
Treatment involves a multidisciplinary approach to include anti-inflammatory and antithrombotic therapy (like aspirin or other anticoagulants) and identification and management of underlying conditions to prevent further strokes and complications.
Our providers
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Meaghan A Kelly, MD
Pediatric Neurology
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Thuy Nguyen, MD
Neurology, Pediatric Neurology & Epilepsy Neurology
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Paola Pergami, MD MDDO
Pediatric Nephrology & Pediatric Neurology
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Our locations
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MedStar Health: Pediatrics at Tenleytown
4200 Wisconsin Ave. NW 4th Floor Washington, DC 20016
MedStar Health: Pediatrics at Leonardtown
26840 Point Lookout Rd. Shanti Medical Center Ste. 5 and 6 Leonardtown, MD 20650
MedStar Health: Comprehensive Stroke Center at MedStar Georgetown University Hospital
3800 Reservoir Rd. NW 7th floor PHC Washington, DC 20007
410-354-5956
Frequently asked questions
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What is a stroke, and how common are they for children?
A stroke is a type of cardiovascular disease that interrupts the flow of blood and oxygen to the brain. Strokes may be ischemic (caused by a blocked blood vessel) or hemorrhagic (caused by a burst blood vessel).
Strokes are often mistakenly thought of as a problem that affects only the elderly. Although strokes are more common in adults, they can also affect infants and children. As many as one in 1,600 infants experience a stroke at birth each year, as do as many as 13 in 100,000 older children.
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What are the risk factors for a pediatric stroke?
Risk for childhood stroke can be increased due to maternal factors, congenital heart defects, infections, immune disorders, blood disorders, or trauma (for example, a head injury).
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What are the signs and symptoms of a pediatric stroke?
Because it is critical that children who have experienced a stroke receive medical care as quickly as possible, it is important to know the signs. For infants, these signs include seizures (marked by sudden stiffness or the whole body or part of the body, twitching or spasms, or non-responsiveness) or weakness on one side of the body.
Signs of a stroke in older children include headaches; weakness or numbness on one side of the body; drooping of one side of the face; or changes to speech, vision, or movement.
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How are pediatric strokes assessed and treated?
If you think your child is having a stroke, you should get them to the Emergency Department without delay. Early intervention from a specialized stroke team can help minimize injury to the brain and prevent complications or permanent disability.
At the hospital, your child will receive imaging tests — for example, CT scans, MRIs, or angiograms — to detect any bleeding in the brain. An echocardiogram may be used to examine the structure of your child’s heart. Neurological tests and other exams may also be conducted.
If needed, your child may be given anticoagulant medication or aspirin to prevent blood clots. Some children will need to remain on those medications long-term. Depending on the cause and severity of the stroke, other treatments may also be needed.
Children who have had a stroke require medical monitoring and, often, rehabilitation services like physical, occupational, and/or speech therapy. MedStar Georgetown offers a full spectrum of follow-up care. With quality medical care, many children make a full recovery from a stroke.
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Who do I call if I am concerned about my child?
You should call your pediatrician immediately and/or one of our Comprehensive Stroke Centers. There is always a neurologist on-call after hours and on weekends to answer your questions and help with any concerns. It your child is having a stroke, time is critical.
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Will my child fully recover from a stroke?
Many children, especially if very young, can recover completely or very well. Important issues are the size and location of the stroke and whether risk factors for stroke can be identified and possibly treated. Rehabilitation by means of physical therapy, occupational therapy, and speech therapy is extremely important for long term outcome.
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What tests will my child need to evaluate him/her for a stroke?
In the emergency department, your child will need a CT scan to make sure there is no bleeding in the brain.
The emergency room doctors and the neurologist will examine your child for any neurologic deficit. Based on the history and neurological examination, further studies will be decided. Eventually, an MRI of the brain as well as a MR angiogram will be done to fully evaluate the extent of the stroke and to visualize his/her blood vessels in details.
The neurologist will determine whether your child needs anticoagulation with IV heparin depending on the brain imaging. If your child does not require anticoagulation, he/she might receive daily aspirin. Additional laboratory tests may be needed later based upon your child’s symptoms.
After your child is admitted to the hospital, he/she will likely need an echocardiogram of his/her heart. This is done to see if the child’s heart has a normal structure and to make sure that there are no clots that could have gone to the brain.
Even if no risk factors are found in your child during the hospital stay, your child will still require rehabilitation services and will be followed in the neurology clinic after his/her discharge from the hospital.