Photo of a smiling child

Pediatric Stroke and Vascular Service

The Pediatric Stroke and Vascular Service at MassGeneral Hospital for Children cares for premature infants, children or adolescents who have had an ischemic or hemorrhagic stroke, or cerebral venous sinus thrombosis.

Contact the Pediatric Stroke and Vascular Service: 617-726-2737

Make an Appointment

Overview

The Pediatric Stroke and Vascular Service cares for premature infants, children or adolescents who have had a stroke, whether ischemic or hemorrhagic, or who have had cerebral venous sinus thrombosis. The service is a specialized team comprising a stroke neurologist, a pediatric hematologist, a pediatric general neurologist, pediatric neuroradiologists, pediatric intensivists, neurosurgeons, a laboratory coagulation specialist and a stroke nurse. Our team provides continuity of care, following a patient from admission to the Neonatal Intensive Care Unit or Pediatric Intensive Care Unit to discharge.

We have expertise in:

  • Acute stroke management in older children and adolescents
  • Strokes in neonates and infants
  • Neurocritical care
  • Brain imaging evaluation of stroke and cervico-cranial vascular disorders
  • Consultations for arterial dissections, vasculitis, Moya-moya disease, coagulation and hematological disorders, congenital or genetic causes of stroke, cavernous or arteriovenous malformations (AVM), aneurysms, cardiogenic sources of embolism and acute intra-arterial thrombolysis management
  • Counseling families of children with thrombophilia or with a family history of stroke
  • Evaluation and management of post-stroke seizures

Counseling relatively healthy young people who have one or more close relatives with stroke about their risk of stroke is an important part of what we do. This risk assessment extends to congenital thrombophilia, vascular factors and possible interventions or medications to minimize risk. In addition, we offer evaluations for other cerebrovascular disorders, such as arterial dissections, aneurysms and arteriovenous malformations.

The Pediatric Stroke and Vascular Service at MassGeneral Hospital for Children is one of the oldest and largest in North America. Among the more frequent diagnoses that we see are acute ischemic stroke and vascular disorders masquerading as possible stroke. A very special role is the assessment and management of stroke risk in young children and adolescents whose parents and close relatives have suffered stroke(s) in young adulthood.

Members of the Pediatric Stroke and Vascular Service are currently evaluating the role of plasma phase risk factors in pediatric stroke, including lipoprotein (a). We are also interested in the possible predictive role of circulating tissue factor-positive microparticles. Our team participates in the International Pediatric Stroke Study (IPSS). 

Newly Diagnosed

You have just been told your child suffered a stroke. First of all, you are not alone! There is a lot you can do to help your child.

If your child has recently received a diagnosis of stroke you’re probably experiencing a variety of emotions and you probably have hundreds of questions about the condition, the prognosis, and available treatments. The Pediatric Stroke and Vascular Service is here to help your child, to offer hope, and to provide information and resources that may be useful to you and your child in this journey

What Do I Do next?

Newborns

If your newborn has been diagnosed with stroke close monitoring, control of seizures and evaluations are necessary to prevent further injury to the brain and optimize the changes of his/her neurological development and recovery. It is very important that your baby is evaluated by a Pediatric/Perinatal Stroke Team as soon as possible. You can request to speak with the specialist in the hospital you are at, request a transfer to a hospital with pediatric stroke services like Mass General or contact us anytime at 617-726-2000 (paging Child Neurology on call physician).

Infants and Children

All patients with symptoms of stroke, regardless of age, need to be assessed immediately by health-care professionals.

Urgent concerns

Infants with early hand preference before 18 months should see their family doctor or pediatrician and request a referral to pediatric neurologist. Your primary care physician can request a consultation with the Pediatric Stroke and Vascular Service at 617-643-0241.

Strokes can happen at any age (PDF) | Spanish (PDF)

About this Program

Children with stroke often see a number of health care professionals. Each child is different and may be required to see a number of specialists. However, some children may only be followed by a pediatrician, stroke team and physical therapist, while other children may see additional specialists, depending on their needs.

On arrival, please check in at the front desk of Yawkey 8B (Pediatric Hematology). Typically sixty minutes are scheduled for your first appointment and thirty minutes are allotted for follow-up appointments. However, due to the complexity of this visit, it is not uncommon to be in the clinic for up to two hours. If laboratory tests are indicated, you may chose to have them done during your visit to our clinic. At the end of your appointment, you will be able to schedule a follow-up appointment, if necessary.

Typical Evaluation at the Pediatric Stroke Clinic

Physicians who work in the Multidisciplinary Pediatric Stroke Clinic offer comprehensive patient evaluations. You may see up to three doctors during your appointment; however, they may see you and your child sequentially or as a group. In either case, you will be able to remain in one exam room for the entire appointment.

A member of the team will begin by reviewing your current concerns and your child’s symptoms. Following this the doctor will ask you about your child’s medical and neurologic history, family health history, and his/her social history. The physician will also ask about your child’s development.

Following this detailed history, the physician will perform a physical exam. The physical exam will include, in addition to a focused general exam a detailed neurological examination.

Once the physical evaluation is complete, the physician team will review their findings with you. Together you will discuss possible further testing and/or a treatment plan. Our staff, at the front desk, will assist you with setting up future testing, if needed. Please note that no formal neuropsychological testing will be performed during your exam in the neurology clinic.

Meet the Team

Pediatric Stroke Team thumbnail links to PDF about the team
Learn more about the pediatric and young adult stroke team.

Clinical Co-Directors

Faculty

Our multidisciplinary team offers coordinated and comprehensive care for babies and children with stroke. Our care does not stop at 21. As part of the Massachusetts General Hospital Fireman Vascular Center and the Stroke Service at Massachusetts General Hospital, we provide continuity of care throughout the entire life span of our patients.

Anesthesia, Critical Care & Pain Medicine

Child Life Specialists

Clinical Pathology

Clinical Social Worker

Neurology

Neurosurgery

Obstetrics & Gynecology

Orthopaedics

Pediatrics

Psychiatry

Psysiatrist/Physical and Rehabilitation Medicine

Radiology

Patient Resources

Outdoors Rx

The Appalachian Mountain Club (AMC) and MassGeneral Hospital Pediatric Stroke Clinic collaborate on Outdoors Rx™, an innovative program that gives healthcare

Photo of family enjoying AMC program

professionals dedicated resources for prescribing regular outdoor physical activity to children. Created by AMC, Outdoors Rx takes a unique approach to “filling” outdoor play prescriptions by removing cost and lack of experience as the biggest barriers for families who are new to the outdoors and unfamiliar with local urban parks and trails. Outdoors Rx guided programs are completely free, close to home, and often the first step to getting outdoors for patients and their families. Equipped with basic know-how, families are more inclined to start exploring the outdoors on their own using the Outdoors Rx website.

Why get your kids outside?

Photo of family enjoying AMC program
  • Improves concentration
  • Lowers stress and improves mood
  • Increases level of Vitamin D
  • Increases creativity and problem-solving abilities
  • Helps connect with friends and family
  • Promotes a healthy weight
  • It’s fun!

Non Profit Pediatric Stroke Organizations

The Children’s Hemiplegia and Stroke Association helps children who have survived an early brain injury that results in hemiplegia or hemiparesis (weakness on one side of the body).

The International Alliance for Pediatric Stroke (IAPS) was created to unite pediatric stroke communities around the world. IAPS provides knowledge, hope, resources and connections between families, medical specialists, researchers, healthcare providers and anyone affected by pediatric stroke.

Brendon’s Smile provides opportunities to advocate and raise awareness among the general public locally and online.

The Children’s Stroke Foundation has a simple mission: to educate doctors throughout the United States about pediatric stroke.

The Bellaflies Foundation is dedicated to spreading pediatric stroke awareness, supporting children's hospitals, and working to advance pediatric stroke research in medicine and testing worldwide.

The I am Jayden Foundation spreads awareness about pediatric stroke and provides funding for organizations/foundations/survivors associated with pediatric stroke.

The Sickle Cell Disease Association of America promotes finding a universal cure for sickle cell disease while improving the quality of life for individuals and families where sickle cell-related conditions exist.

Losta Helping Hands powers online caring communities that help restore health and balance to caregivers’ lives.

The Access Sports America inspires higher function and fitness for children and adults of all disabilities through high-challenge sports and training.

The American Stroke Association is dedicated to prevention, diagnosis and treatment to save lives from stroke — America’s No. 5 killer and a leading cause of serious disability.

The Brain Injury Association of America is the country’s oldest and largest nationwide brain injury advocacy organization.

Support Groups

Family Ties of Massachusetts provides information and referral services, emotional support and training to parents of children and youth with special needs.

HemiChat is a parent-led UK charity built on support relating to babies, children and young adults living with Hemiplegia.

Therapies: Mass General Affiliates

Composed of more than twenty-five locations throughout Massachusetts, the Spaulding Hospital Rehabilitation Network offers specialized and customized care in pediatric rehabilitation. Treatment includes on-site therapy housing, PT/OT, speech therapy, state-of-the-art technologies, support groups and more.

The Speech, Language and Literacy Center at the MGH Institute of Health Professions offers comprehensive assessment, therapy and specialty services for speech and language disorders in children of all ages. Treatment can be individual or in a group setting, and is mostly free.

The Mass General Department of Speech, Language and Swallowing Disorders offers a complete continuum of care, including diagnosis and treatment, to patients of all ages with any type of communication or swallowing disorder.

The Lurie Center for Autism is designed to evaluate and treat children with a variety of conditions including neurological disorders. Treatment includes individualized care plans that incorporate the caregiver, physician, school and community programs.

North Shore Medical Center offers a comprehensive neurology program for children suffering from neurological conditions. Treatment includes PT/OT, speech language, behavioral health, and educational planning, including a Neurodevelopmental Center.

Ranked one of the top hospitals in the U.S. by U.S. News & World Report, Newton-Wellesley Hospital offers the best of pediatric care and treatment in neurology.

MGH Revere HealthCare Center offers expert outpatient services for children using the latest clinical innovations. Services include the Neurology clinic; the Speech, Language, Swallowing Disorders and Reading Disabilities Department; and the Youth Zone.

Government Agencies

Mass Mental Health
Mass Home Care
MassMatch
Home Care Alliance of MA

Government Programs

The following services vary from state to state.

Medicaid Waiver ProgramFederal information on the Medicaid waiver program. This program is NOT based on parent income. It is based on the child’s income and many children with hemiplegic cerebral palsy will qualify.

Fact Sheets

InsureKidsNow.gov
Medicaid
Social Security Benefits for Children with Disability (government pamphlet)

Conditions

Thumbnail links to PDF about genetic conditions and stroke
Learn more about genetic conditions and stroke.

Hereditary Hemorrhagic Telangiectasia (HHT), also known as Osler-Rendu-Weber Syndrome, often results in nosebleeds and other bleeding problems throughout the body. The Mass General HHT Center emphasizes the importance of the first step of making the correct diagnosis. We provide confirmatory genetic testing, genetic counseling, obtain multidisciplinary evaluations, and coordinate specialty care. Our team works with a patient’s primary-care provider to identify specialty needs, which improve care and outcomes.

Genetic Thrombophilias: A genetic mutation that cause blood to clot by block blood flow.

Sickle-cell anemia: A disease in which the body’s hemoglobin has an irregular shape, and so tends to cause blood clotting and blocked vessels

MoyaMoya: A rare, progressive disease in which arteries are blocked in a region of the brain called the basal ganglia (http://www.ninds. nih.gov/disorders/moyamoya/moyamoya.htm).

Vascular Malformations: An abnormal connection between the arteries and veins in the brain that usually forms before birth.

Fabry disease: A genetic disease that causes an excess of fat buildup in the body’s cells. Complications can lead to stroke

Homocystinuria: A genetic disease in which the body is unable to process certain proteins, and so increases the risk of blood clotting

Marfan syndrome: A genetic disorder in which the proteins of connective tissue are mutated. This can cause a variety of symptoms depending on affected tissues, including stroke

Ehlers-Danlos syndrome: A genetic disorder that encompasses a group of connective tissue disorders, primarily focused on mutations in collagen and its associated proteins. This disease can lead to a variety of symptoms, including stroke.

CADASIL/CARASIL (Cerebral Autosomal Dominant Arteriopathy with Sub-cortical Infarcts and Leukoencephalopathy): A genetic disease that causes the walls of blood vessels to thicken, and so prevent blood flow.

Mitochondrial Encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS): A disease caused by mutant mitochondria that affects both the nervous system and muscles. It is often characterized by a buildup of lactic acid, and often causes stroke.

Loeys-Dietz Syndrome: A genetic disorder that affects the connective tissue in many parts of the body. Connective tissue provides strength and flexibility to structures such as bones, ligaments, muscles, and blood vessels (http://ghr.nlm.nih.gov/condition/loeys-dietz-syndrome).

ACTA2: A genetic disorder that causes multisystemic smooth muscle dysfunction. This disorder impairs the activity of smooth muscles throughout the body and leads to widespread problems including blood vessel abnormalities (most commonly involving the aorta), decreased response of the pupils to light, a weak (hypotonic) bladder, and impairment of the muscle contractions that move food through the digestive tract (hypoperistalsis)

Atrial Fibrillation: A common condition in adults but not in children of having an irregular heartbeat, of which can lead to blood clotting and blocked vessels

Contact

Contact Us

Pediatric Stroke and Vascular Services

Yawkey Center for Outpatient Care

Suite 8B32 Fruit Street Boston, MA 02114
  • Near Public Transit
  • Accessible
  • Phone: 617-726-2737
  • Fax: 617-724-0702

Emergencies: Call 911 first and 617-726-2066 to reach the Pediatric Neurology Fellow on call if your child develops sudden weakness, changes in speech, numbness or difficulty walking or with coordination.

Clinic appointments: contact our coordinator Sue Ann Waterman.
Phone: 617-726-2737
Fax: 617-724-0702

Map and driving directions to Pediatric Stroke and Vascular Services (choose Yawkey Center for Outpatient Care)

Make an Appointment

Before making an appointment, new patients should contact the Mass General Registration and Referral Center at 866-211-6588 to receive a patient number and a Medical Record Number (MRN). Please have the following information available:

  • Name
  • Address
  • Date of Birth
  • Social security number
  • Insurance information
  • Emergency contact information

After you have registered as a new patient, contact the Pediatric Stroke and Vascular Service coordinator to make an appointment.

The Pediatric Stroke and Vascular Service is a multidisciplinary clinic, including a pediatric hematologist, pediatric neurologist, and stroke neurologist. This means that your child will see up to three specialists at your appointment. For this reason, please anticipate that your clinic visit time may extend up to two hours.

Before Your Appointment

If your child has been treated at another facility, copies of your child’s past medical records and scans must be received prior to your scheduled appointment. Please note that not all children seen in the Pediatric Stroke Clinic will have had all of these tests performed. Examples of prior medical records and tests necessary for this consult are:

  • MRI or CT imaging
  • Discharge summaries from any recent hospital admissions
  • Reports from past neurologists
  • Lab Results, especially Pro-clotting Studies (“hypercoagulation studies”) on child and/or parent
  • Cardiology Reports or Echocardiogram Reports
  • Neuropsychological testing
  • Early intervention or school based developmental testing
  • EEG reports
  • Results from metabolic or biochemical testing

Unless otherwise specified, your child does not need to do anything specific to prepare for their appointment in the Pediatric Stroke Clinic. They should eat, sleep, and play as they would normally the day of the appointment.

On the day of the Appointment

Most parents bring a list of questions to ask during the visit. The professionals are here to help your child and will answer any questions you may have. Coming with a list of questions ahead of time will be very helpful for your child’s future care.

  • Be prepared to pay any insurance copayments and/or deductibles
  • Bring the following information with you to help you fill out any necessary paperwork:
    • Insurance card, including your policy number and/or Medicare or Medicaid card
    • Your referral from your PCP if required
    • Name, address and phone number of your referring or primary care physician
    • Health care proxy form

Finding Your Way

  • Massachusetts General Hospital Campus Map
    Find interactive and downloadable maps of the hospital campus. Use the Interactive Main Campus Map to find directions to specific buildings.
  • Shuttles
    A free shuttle service is available to and from several Massachusetts General Hospital and Partners Healthcare facilities.
  • Patient Drop-off and Pick-up
    Patients who are being dropped off or picked up from Massachusetts General Hospital can be picked up at specific locations on the hospital's main campus.
  • Special Assistance
    Special assistance is available to patients arriving or leaving Massachusetts General Hospital, including assistance getting out of a car or into a wheelchair.
  • Local Boston Information
    Visit this page for information on accommodations, public transportation, Logan Airport and other topics.

News

  • Neuroscience Center Innovates, Grows - 4/25/2012, Mass General

    The Neuroscience Center at MassGeneral Hospital for Children is a growing program designed to accelerate research and provide state-of-the-art care for children with neurological disorders.

  • Research of Eric F. Grabowski, MD, DSci - 8/19/2011, Research

    Research prograpm of Eric F. Grabowski, MD, DSci, Associate Professor of Pediatrics, Harvard Medical School; Pediatrician, Massachusetts General Hospital; Director, Cardiovascular Thrombosis Laboratory; Director, Program in Pediatric Hemophilia and Thrombosis; Co-Director, Pediatric Stroke Services

Contact the Pediatric Stroke and Vascular Service: 617-726-2737

Make an Appointment

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