>> Hello my name is Dr. Rebecca Ichord. I'm a neurologist at The Children's Hospital of
Philadelphia and director of the Pediatrics Stroke Program. Stroke in childhood is an
important problem. Although it's rare, when it happens, it's a serious emergency and it's
important for the general public as well as health practitioners to understand the
signs and symptoms.
In the case of a child having an acute stroke, their symptoms may be among the following:
They may suddenly have difficulty understanding where they are, who's around them. They may
have sudden loss of their ability to speak or understand speech. They may suddenly lose
the ability to see things on one side of their body. They may have sudden loss of strength
or sensation involving the face, the arm and the hand or the leg. Or they may have sudden
difficulty in balance and gait.
And if these symptoms should occur, the child should be considered to possibly be having
a stroke. And the thing to do in that situation would be to have the child lie flat, do not
give him anything to eat or drink, and call 911. And when the emergency responders arrive
they should be told that the child's having signs and symptoms of what could be a stroke.
We call this a brain attack and it should be treated as an emergency.
Today we're going to do a check-up of a young man who had a stroke sometime in the past.
And he has kindly allowed us to check him out today so we can show some of the signs
and symptoms that we might see on an examination. Are you ready? All right, tell me your name.
>> And so I'm checking to see if he's aware of himself and his surroundings. And who's
that lady over there?
>> My grandma.
>> OK, and so you know where you are?
>> CHOP
>> That's right. And what year is it?
>> 2015.
>> OK, so we figured out that you know who you are, who's around you, where you are and
the date. And this is what we call orientation. A child who is having an acute stroke may
have some confusion and be unable to describe where he is or who is around him.
Now I'm going to ask you to do some little tests that have to do with your speech. And
testing speech is a very critical part of evaluating for signs and symptoms of a stroke.
Some children may only have a loss of their speech as the sign of their stroke. And so I'm
going to ask you to do a few things.
Let's do, let's see if you can repeat what I say. Little children like to play outdoors.
>> Little children like to play outdoors.
>> Excellent, so I'm listening to hear how well he can formulate the words, how well
he can make the sounds clear. Now I'm going to ask you to remember some words that I'm
going to ask you to say. We call this recall. And I'll ask you now, and then I'll ask you
again a little bit later. And tht's called delayed recall. Children who have an acute
stroke may have trouble with recalling, or remembering words that they had just heard.
You ready? Red, pencil, bridge. Go ahead and tell me.
>> Red, pencil, bridge
>> 100%, I'll ask you again in a few minutes. Now I'm going to ask you to name some things.
So naming is another aspect of speech. And some children have difficulty with naming
objects. So here we go. See these pictures, these are very simple, easy pictures. I want
you to say the name of each thing. You ready? And what do you call that?
>> Clock, T-shirt, pencil, baseball, skateboard and bike
>> Excellent, so he got them all correct. And in addition I could understand the words
very clearly. In a child who's having a stroke that affects speech, they have trouble getting
the word out, or they may say the wrong word, or they may not be able to say the word at
all. So your naming is great.
All right, let's move on to some other things. Now I'm going to look at your vision. I want
you to look at my nose right here. And first of all I notice that when you look at me,
your eyes are looking straight ahead. And if I move your eyes follow me. So that tells
me that you're able to see things well enough to have your eyes look where they need to
look. And children who have a sudden loss of vision on one side, their eyes may prefer
to stay looking in one direction. So it's very good, it's very normal that your eyes
are looking straight at me.
And now I'm going to test each eye by itself. And this is a way that we can tell if the
vision problem is involving both eyes or just one, or it's in the brain. Looking right here
at my nose I'm going to cover your eye. And keep looking straight at my nose. Now what
this is is called testing visual fields. And it's simply showing a number and you tell
me how many fingers you see. Ready, how many?
>> One, two
>> How many?
>> Two, one
>> Good, so I'm showing a finger in each field and to see if he can check them. And he got
them all right. Ready, here we go with the other eye.
>> Two, four, one, two
>> OK, so in the case of a child having a stroke, if I cover one eye and if I show him
numbers over here and he gets these correctly, then I know this visual field is normal. If
I show them over here, for example, and he can't see them clearly on this side, that
would mean that he has what we call visual field loss. And that's a typical kind of abnormality
in an acute stroke that helps us neurologists to figure out where the problem might be.
Very good, OK, now let's see how your eyes are moving. Can you look at my thumb? And
watch where it goes. Very good, and so his eyes are able to follow in all directions.
And in some children who have certain areas of the brain that control eye movements, where
there is a stroke in that location, they may not be able to move their eyes in all directions.
But you did 100%.
OK, let's look at your face. Can you give me that big smile again, excellent. And so
we notice that his face is very strong, that his smile is very strong on both sides. And
in the case of a child who has an acute stroke, the one side of the smile might be not present
and be very weak. All right, let's have you close your eyes really, really tight. And
you can see that he's able to squeeze his eyes tight on both sides. In a child who's
having an acute stroke with weakness of the face, they may not be able to close the weak
side of the face, that eye very tightly. That's good you can open your eyes. Your eyes, your
face is very strong.
And now just again look straight at me, I'm going to check the sensations. So I want you
to tell me if the two sides feel the same or different.
>> Same
>> Same?
>> Same, same
>> And let's go on down to your arms. Same or different?
>> Same
>> Same or different?
>> Same
>> Same or different?
>> Same
>> And again, in the case of a child who might have a stroke that affects sensations on one
side, they may tell me that on one side of their body or one side or their face, it doesn't
feel the same as the other side. I'm going to check your ability to hear. Ready? OK,
I want you to point to where you hear the sound.
Good, very good. So again, in a child how might have loss in their hearing you would
expect to see possibly some loss in being able to detect hearing that little soft brush
of the fingers on one side.
OK, let's move on down, we're doing great here. Can you show how you shrug your shoulders?
All right, and what we notice is that his shoulder is a little weak on that side, he
can't raise it quite as much. Although he is trying really hard. OK, that's good. So
there's weakness on that side. And then let's look at your arms, can you hold your arms
up like this for me? How about keeping them straight in front? And I'm going to let go.
Keep your arms in front of you like that, and then try to turn your arm over like this.
And so you can see this side moves very well, but this side he can't move quit so well.
And that's because there's weakness on this side of the body.
And again, in the case of a stroke, a child may be unable to lift that arm, or open their
hands. Let's see both of these hands, can you make that hand spread open? Beautiful,
and make it a little "O" like that. And make your hands tap like that. And that's good,
that's what we like to see. And the weak side, he can't really make the hands open. Let's
see what you can do. I know you're willing it, and it just won't open. And how about
if you try to make that "O". Can't quite do it. And can you tap it at all, no?
So he's lost the fine dexterity and the strength that it takes to control that hand in a normal
way. And so that's what we might see in a child who has a stroke that affects strength
on one side of their body. And it tends to especially involve the face and the arm and
the hand. And then we see that combination, then that's a situation where we especially
would worry about a stroke being, going on in that child.
So let's see onto your legs now, right. So let's see, can you lift this knee up in the
air like this? Good, keep it there really strong. And I'm pushing, pushing, and I can't
push it at all. So that's very strong. How about this one? And you're having to work
just a little harder to make that strong. Let's make your legs straight now. Keep it
there nice and strong. And I'm gonna try and bend it. And I'm not able to bend it because
it's too strong. OK, how about this one?
So right away we can notice that this leg, he can't quite get it all the way straight.
And if I try to push it down, I'm able to push it down a little bit. And so that's again,
sign of weakness. And so what we see is weakness of the shoulder, the arm, the hand and the
leg. And that's the typical distribution, the typical location of loss of strength involving
someone who has a stroke.
That's right, OK, now let's check your walking, you ready? There we go, can you stand over
here? That's it. And what you may notice is that because the left leg is a little bit
weak, he can't really keep it straight. And also the left arm is a little weak so it tends
to kind of hang here a little bit more than the right side.
Now let's see how you can walk. And so he can't really push off quiet as strong with
that left side. And come on back this way. And that left side just can't make it, can't
make it as strong and straight as the right side. All right, very good, you can sit up
here. Very good. And you can see, he's figured out how to get around even though he's weak
on that left side. But even though he's figured it out, he still has a little trouble and
has to compensate for the weakness in that left side.
Alright, do you remember those three words? What were they?
>> Red, pencil and bridge
>> Excellent, so his recall is very good. All right, I think we're done.