Pediatric stroke recovery starts with fast action

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Conductive education is based on the theory of plasticity, the idea that the brain and central nervous system can create new neural pathways to replace damaged ones.

"The pediatric brain is much more plastic than the adult brain," said Dr. Lisa Abraham, a neurologist and coordinator of the pediatric stroke division the Children's Hospital of Pittsburgh.

The division, established last July, aims for quick and appropriate imaging of victims of pediatric stroke. With kids, she said, "the main goal is to find out the underlying cause.

"If there is a recurrent risk, we want to do something about it."

There are a number of causes of pediatric stroke: heart abnormalities, genetic diseases, infection, sickle cell disease. There may be an inflammation in the placenta. Some, as in Jacob's case, have no known cause.

Fast and appropriate diagnosis in children may be even more important than for adults, because there are so many more aspects of recovery. Yet the signs can be elusive.

For example, she said, neonates (under one month old), are still functioning from the brain stem, not the cortex, so any sign of stroke damage to the cortex would be hard to diagnose.

As time passes, a baby showing a strong early hand preference, as Jacob Bartolowits did, may be an indicator of stroke, as may behavioral problems.

Whatever the cause, Dr. Abraham said, the range of recovery can be huge, even among children who have damage to the same area of the brain.

Initial treatment may be aspirin or IV heparin (a blood thinner), and Dr. Abraham said there are some collaborative trials underway across the country to determine if the clot-busting drug tPA, used to treat adult stroke patients, could be used in children.



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