Unraveling the Mystery of Pediatric Stroke

When you picture someone having a stroke, it’s probably a senior citizen. And for good reason. Each year, nearly 800,000 people in the United States suffer a stroke, and the majority are over age 65. But a small fraction — about 4,000 — are children.

The devastating consequences they face can last the rest of their lives: difficulty with speech, physical impairments, trouble swallowing, decrease in vision, personality changes. That’s why our experts are leading the field to improve treatment for these kids – and working to stop strokes before they start.

“These are kids who are perfectly healthy, and we watch them deteriorate in front of our eyes. I have to do something to try and stop that. There’s really no choice for me.” – Dr. Heather Fullerton

Because pediatric stroke is rare, it’s hard to understand the underlying causes and develop effective treatments, says Heather Fullerton, MD, Chief of Child Neurology at UCSF Benioff Children’s Hospital San Francisco.

Early in her career, Fullerton realized there was a gap in care for these patients: Pediatric neurologists weren’t comfortable treating strokes, since the cases were uncommon and the condition poorly understood. But stroke specialists weren’t comfortable treating kids, since they almost exclusively saw adults.

“A physician might say, ‘Well, this is what I do for a 60-year-old, so this is what I’ll do for the 12-year-old I’m seeing now,’” Fullerton says. “But they can’t be handled the same way.”

So Fullerton embarked on a quest to find out why kids have strokes, and to provide patients a place to come for world-class care. In 2006, she established the country's first pediatric stroke center at UCSF, which now draws patients from across the nation. Three years later, she launched the first comprehensive research study to unlock the mysteries of pediatric stroke, enrolling more than 700 children at 37 hospitals worldwide to determine the role that viruses play, something that had long been suspected but never confirmed.

Her team discovered that almost half of children who had a stroke also had an acute herpes virus infection, which causes cold sores, chicken pox and other common illnesses. That knowledge has influenced how physicians treat stroke. Previously, doctors would sometimes prescribe steroids to reduce inflammation, but these drugs can worsen a herpes infection. Doctors now check for herpes or give an anti-herpes medication along with steroids.

Fullerton is taking her research further by leading a second study, this time tapping into groundbreaking technology developed at UCSF by Dr. Joe DeRisi, Professor of Biochemistry and Biophysics. By comparing data from hundreds of kids, the study aims to find patterns among stroke victims and pinpoint infections that increase risk, which will offer new clues about prevention and treatment.

The ultimate goal, Fullerton says, is to prevent pediatric stroke. She’s got a long way to go, but she has strong motivation: her patients.

“These are kids who are perfectly healthy, and we watch them deteriorate in front of our eyes,” she says. “I have to do something to try and stop that. There’s really no choice for me.”