Strokecast

Episode 049 — Stroke in Children with Dr. Heather Fullerton

'Strokes will happen in as many as about 1 in 2200 live births' -- Dr. Fullerton, @UCSF #stroke #pediatric Click To Tweet

 

Many folks are surprised to find out adults in their 20s, 30s, and 40s can have stroke. What’s often bigger news to people is that adolescents, children, newborns, and even fetuses can have a stroke. In fact, stroke in the womb is one of the leading causes of cerebral palsy.

Stroke in kids was nothing I had never even thought about before I started this journey to learn more about my own brain injury.

This week, I talk with one of the leading experts in childhood stroke. Strokecast regular, Dr. Nirav Shah, introduced me to Dr. Heather Fullerton. We had a fascinating conversation about stroke in children, the causes, and the generally optimistic recovery path.

'Being born is a time period where you're at increased risk of having a stroke.' -- Dr. Fullerton, @UCSF #stroke #pediatric Click To Tweet

Bio

Dr. Heather Fullerton headshot

Dr. Heather Fullerton is a pediatric vascular neurologist at UCSF, one of only a few child neurologists in the country with additional board certification in vascular neurology. She is the Kenneth Rainin Chair in Pediatric Stroke Care, Chief of Child Neurology at UCSF Department of Neurology, and director of the Pediatric Stroke and Cerebrovascular Research Group and Pediatric Brain Center at UCSF Benioff Children’s Hospital.

After graduating from Baylor College of Medicine in 1996, Dr. Fullerton came to UCSF for her pediatrics residency and child neurology fellowship, and then joined the child neurology faculty in 2002. Early in her training, she cared for a 2-year-old girl who suffered a stroke caused by a tear in a neck artery from a fall. After realizing the paucity of research in this field–and lack of child neurologists with expertise in stroke–she chose to dedicate her career to the care of such children.

She completed a vascular neurology fellowship between 2002 and 2003, and a two-year master’s degree in clinical research at UCSF in 2005. She began doing clinical research in the field of childhood stroke, collaborating with renowned adult stroke researchers at UCSF. After starting a pediatric stroke clinic in 2002, she later established the multidisciplinary Pediatric Stroke and Cerebrovascular Center in 2006 and Pediatric Stroke and Cerebrovascular Research Group in 2009.

'Mothers are hypercoagulable, meaning they form blood clots more easily, when they are giving birth…the baby also forms blood clots more easily ' -- Dr. Fullerton, @UCSF #stroke #pediatric Click To Tweet

Dr. Fullerton’s research efforts have already improved the care of children with stroke.

She has performed novel work identifying which children with stroke are at risk for suffering a recurrence. This information not only guides physicians in determining which high-risk children need preventative treatment, but also provides enormous reassurance to families of children with low recurrence risk.

She led a groundbreaking study on risk factors for childhood stroke, determining that both minor acute infections and recent trauma are stroke and common risk factors.

She has also published work on pediatric arterial dissections, ethnic and gender disparities in childhood stroke risk, stroke rates in children with sickle cell disease, hemorrhagic stroke risk in children with arteriovenous malformations, and neurodevelopmental outcomes in children with vein of Galen malformations and PHACE syndrome.

She led an NIH-funded international study with 35-plus enrolling sites to better understand the association between childhood infections and ischemic stroke. She currently leads the part 2 of the said NIH-funded study to explore further analyses and test the overall hypothesis . She leads an AHA funded study on predicting stroke risk after minor trauma.

'Those young infants are more likely to present with seizures. And if they don't have seizures, they just might present with excessive sleepiness.' -- Dr. Fullerton, @UCSF #stroke #pediatric Click To Tweet

She also mentors junior investigators on a variety of other stroke related studies: stroke risk in childhood cancer survivors , stroke prevention in sickle cell disease, risk of epilepsy after stroke , the association between migraine and stroke in children, ADHD medications as a risk factor for stroke, and the role of atherosclerotic risk factors in stroke in children and young adults.

Tips for Living with a Child that Survived a Stroke

'It's also fairly common in children for the neurologic symptoms of a stroke to wax and wane.' -- Dr. Fullerton, @UCSF #stroke #pediatric Click To Tweet

Dr. Fullerton offered these additional tips.

Don’t blame yourself. You will wrack your brain thinking of some way that you could have prevented your child’s stroke. You couldn’t. It was not your fault.

Enjoy your child for who they are, and know that their disability will make them a more empathetic person. A teenage survivor of a neonatal stroke once told me that if she could erase what had happened to her, and get rid of her disability, she wouldn’t. She knew it gave her a different lens for viewing others with disabilities, whether physical, intellectual, or social, and felt that made her a better person.

'Whipping out that phone and taking some brief videos can actually be really important.' -- Dr. Fullerton, @UCSF #stroke #pediatric Click To Tweet

Hack of the Week

Using a phone one handed is certainly an option. As phones get bigger and we prefer to look at bigger screens, though, one handed uses is more challenging. You have reach further with your thumb to touch other parts of the screen or to tap out a text message, or really to use the functions you paid for.

And you have to do that without dropping it.

You can put the phone flat on a table, and that helps, but then the angle might be uncomfortable.

Instead, look for a dashboard or car window mount for your cell phone. You don’t have to use them in a car. Usually they have a suction cup mount or a beanbag mount that you can use to hold your phone where you want it on your desk, coffee table, or other surface.

Then you can tap away at any part of the screen since you don’t have to hold it in your hand.

BE FAST

Stroke symptom graphic

'Vascular health is important and it starts at a young age.' -- Dr. Fullerton, @UCSF #stroke #pediatric Click To Tweet

Where do we go from here?

  • What do think about the things Dr. Fullerton shared? Let us know in the comments below
  • Be sure folks who you know who are involved with kids know that stroke can happen
  • Share this episode by giving folks the link http://strokecast.com/pediatricstroke
    Consider a car mount to hold your cell phone on your desk, night stand, table, etc.
  • Don’t get best…get better

 

'You have a better recovery the more healthy brain you have that can take over the function of the injured brain. That's why we try so hard to prevent multiple strokes in children.' -- Dr. Fullerton, @UCSF #stroke #pediatric Click To Tweet

Strokecast is the stroke podcast where a Gen X stroke survivor explores rehab, recovery, the frontiers of neuroscience and one-handed banana peeling by helping stroke survivors, caregivers, medical providers and stroke industry affiliates connect and share their stories.

5 thoughts on “Episode 049 — Stroke in Children with Dr. Heather Fullerton

  1. As you may have seen in my previous comments, I have Cerebral Palsy. Thank you so much for raising awareness of the similarity of Cerebral Palsy and Stroke! This post was fascinating for me as someone with Cerebral Palsy who has always been interested in how and why a stroke can occur in a baby pre and post birth. The parts about blood flow and blood clots were particularly interesting. An adult stroke survivor who had TPA to relieve his thalamic stroke symptoms once asked me if TPA was used in Cerebral Palsy so I looked into it and to my knowledge it is never used in Cerebral Palsy because the symptoms are discovered WAY after the TPA cut off. Cerebral Palsy is sometimes not diagnosed until years after the injury so we don’t get the early intervention adults get and maybe that’s part of why CP looks a bit different than adult stroke. I also mentor someone who has Cerebral Palsy from a severe brain bleed. I think stroke survivors and people with Cerebral Palsy need to work together on issues relating to treatment, support, and disability rights because our experiences and needs are actually strikingly similar too.
    If your readers are interested here are writings I did about Cerebral Palsy and Stroke. https://www.stromies.com/blog/guest-blog-margot-of-stroke-of-endurance
    http://thenormalityofabnormality.blogspot.com/2018/07/cpcinema-princess.html
    http://cripvideoproductions.tumblr.com/post/167756665756/a-stroke-of-endurance-a-film-by-margot-cole-the
    http://cripvideoproductions.com/about.php

    1. Great points. I’ll have to check out those resources. The thing about tPA, mechanical thrombectomy, and craniectomy is that the treatments are required immediately to prevent further damage. Today, interventional treatments like that can’t reverse the problem; they can just stop it from getting worse. They don’t fix brain cells, the just prevent more from dying.

      With CP, an topic I know much less about, it seems we have a condition that results from stroke or other in utero conditions, that can look different from stroke in part due to the greater neuroplasticity at that age. Overall greater awareness of how the brain gets hurt and repairs/reroutes around damage will help us all.

      And you’re right. There’s a lot to be gained from working with all our neuro cousins — those dealing with Stroke, CP, Parkinson’s, ALS, MS, TBI/Concussion, etc.

      1. Thank you so much for the lovely reply Bill! I appreciate you looking at my links and I hope you find the links helpful! Yes, exactly! Do you find that people often don’t understand that the brain damage from stroke is permanent??

        I ask because people seem to think that treatments I have done over the years are cures for CP when there is actually no such cure in existence.

        Yes it is my understanding some types of Cerebral Palsy occur inside the womb from conditions like Periventricular leukomalacia (PVL) which I’m told looks similar to ischemic stroke on a scan, placental abruption, and big blood clots traveling through the placenta to the fetus’s brain.

        1. “Do you find that people often don’t understand that the brain damage from stroke is permanent??”

          I think that’s a complicated question that actually becomes on of semantics.

          A lot of people never think about it. When the meet a younger survivor is often the first time they’ll even consider the question.

          The other aspect is that while the dead brain parts are dead, and will never come back, it doesn’t mean that the person won’t recover many of those functions. With time and the right work many stroke survivors can recover the functions they lost. Again it will vary a lot, but can happen.

          When someone recovers from their deficits, though, it’s not that the damage has been healed. The brain has worked around those dead areas, established new connections, and gotten the same results a different way.

          It’s why I have more use of my arm now than I did 6 months ago.

          It’s also why many children recover so well; their brains are even more highly adaptive.

          I imagine with something like CP (and you would know better than I) the neuroplastic improvement and recovery is hampered because the damage is done before the brain had a chance to establish those patterns the first time.

          Regardless, dead brain is dead brain. Functions can reroute and new nerve cells can grow, but it doesn’t heal in the same way other injuries do.

          1. Congrats on getting more movement in your arm in just six months Bill! That’s fantastic! I’m sure you will continue to get more movement in that arm. Just remember to stretch the less mobile parts. 🙂

            Exactly. Very true. Its kind of complicated with CP. You are absolutely right that certain patterns are not yet formed leading to some interesting movement habits that I have not seen in adult stroke survivors. Perhaps adults have a sort of circuit memory of how the movement was made by the brain pre stroke leading to a smoother gait than in CP. A bit like the idea of muscle memory. At the same time in CP an amount of brain damage that will kill an adult will produce a child that can still walk so in some ways we are at a huge advantage compared to adults. Less damage is there because the neurons are not formed.

            There’s a woman named Karen Pape that did some Ted Talks on Cerebral Palsy and wrote a book that I think is called “The Boy who could run but not walk” about development of movement and Neuroplasticity in Cerebral Palsy that I suggest reading. I think she believes in “stroke Plateu” though which I’m not thrilled about as I don’t believe in it.

            There’s also “True Strength” by Kevin Sorbo that was very insightful about adult stroke which I highly recommend!

            I have been researching CP in my free time for years . If you ever have questions and want to email about Cerebral Palsy feel free to email me.

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