What are the symptoms? Ischaemic stroke (caused by a blockage in the flow of blood to the brain) is the commonest type of stroke, although in children it occurs in equal frequency as haemorrhagic (bleed) stroke. The causes are abnormal patches of fatty substance in the arteries, hardening of the arteries and arterial thrombosis (blood clot). Sometimes this type of stroke can also occur in patients from a dislodged blood clot in the heart making its way to the brain. Other risk factors for this type of stroke include blood clotting or vessel abnormalities, infections, heart problems and sickle cell disease. Transient ischaemic attack (TIA) is a form of ischaemic stroke often called a ‘mini-stroke’. The distinguishing feature of this type of stroke is that its neurological effects last less than 24 hours and often much shorter. The patient usually fully recovers. The causes for a TIA are similar to a full stroke. Someone who has suffered a TIA is at a much greater risk of a full stroke and therefore a TIA should be regarded as a warning ensuring that urgent investigations are undertaken by a neurologist or stroke specialist. Haemorrhagic strokes result from arterial bleeds rather than occlusions (obstructions). The symptoms however are indistinguishable from ischaemic strokes, although the management is different in terms of investigations, treatment and future prevention. What are the causes? Unlike in older patients where the causes of stroke tend to be diseased atheromatous (fatty degeneration of the inner coat of the arteries or abnormal fatty deposits in an artery) vessels, in younger patients it tends to be abnormalities of the vessels themselves. These can be related to trauma or abnormalities developed from birth. It is important to realise that this does not necessarily mean that the condition is inherited or that offspring will be affected. Also, any vessel malformation tends to be localised (to a small region) and not generalised (across a larger area). Abnormalities of the clotting system can also cause stroke and these would be managed directly with appropriate drugs. In children the cause of a stroke is usually very specific such as a blood disorder or as a consequence of abnormal development of blood vessels in the brain. These abnormal blood vessels tend to be very localised in the brain and not widespread. How is it diagnosed? The diagnosis of stroke in children and young adults is made in the same way as in older patients. The main investigation is a brain scan, usually a magnetic resonance image (MRI). Once the diagnosis is made further investigations are necessary to determine the reason for the stroke. These investigations can include heart and blood vessel scans as well as detailed specialised blood tests. How is it treated? The treatment of stroke can broadly be divided into (i) the stroke itself, and (ii) dealing with the causes of the stroke. After having dealt with the urgent admission it is rehabilitation that is the most important form of management. Treatment is also aimed at any factors that have been identified as the cause of stroke. Recovery in childhood stroke tends to be better than in adult stroke as a child’s brain is usually more flexible and can compensate for the damage. Clinical investigations should be comprehensively taken in a specialised unit. Counselling should be offered to the patient and their family and this may need to be continued as the child progresses through to teenage years and as a young adult. Inheritance patterns and prenatal diagnosis Inheritance patternsThere is little doubt that stroke has an underlying (but small) genetic contribution. However, the likely number of genes and their individual effects are not known. A few directly inherited genetic conditions do exist but these are very rare. Specialised services for these and other familial causes of stroke exist in a small number of neurology centres with a particular interest in genetics of stroke. Prenatal diagnosis This may be possible for an individual member of a family with a known genetic mutation. Is there support? Chest, Heart and Stroke Scotland Advice Line: 0808 801 0899Office: 0131 225 6963Email: firstname.lastname@example.orgWebsite: chss.org.uk The Organisation is a Registered Charity in Scotland No. SC018761, established in 1899. It offers support and a confidential, independent advice line run by trained nurses for people living with chest, heart and stroke illness, their families, carers and health professionals. Group details last updated June 2017. Different Strokes Tel: 0345 130 7172Email: email@example.comWebsite: differentstrokes.co.uk The Organisation is a Registered Charity in England and Wales No. 1092168. It provides information and support for younger stroke survivors and their families. Group details last updated June 2017. Northern Ireland Chest Heart & Stroke (NICHS) Tel: 028 9032 0184Email: firstname.lastname@example.orgWebsite: nichs.org.uk NICHS is a Registered Charity in Northern Ireland No. XN47338. It provides information and support to people affected by chest, heart and lung conditions and stroke, and their families and carers. The Charity offers programmes of health promotion, research and rehabilitation, and runs local support groups. Group details last updated June 2017. Stroke Association Helpline: 0303 303 3100Email: email@example.com Child Stroke Project Manager: 07715 065 925Email: firstname.lastname@example.orgWebsite: stroke.org.uk The Association is a Registered Charity in England and Wales No. 211015. It provides information and support to anyone affected by stroke. The Association offers a Child Stroke Support Service which provides tailored information for children, young people and families. Group details last updated June 2017. Direct services for children and adults affected by stroke are also provided by the Foundation for Conductive Education (see entry Cerebral Palsy).