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Contact the Pediatric Stroke and Vascular Service:
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:
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).
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.
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.
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.
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
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:
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.
Pediatric Stroke and Vascular Services
Yawkey Center for Outpatient Care
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)
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:
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.
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.
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. 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.
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).
All patients with symptoms of stroke, regardless of age, need to be assessed immediately by health-care professionals.
It is very important that families take immediate action and call 911 if you see sudden signs of stroke or sudden changes in your child’s neurological health status. It is much safer to have an ambulance take your child to the hospital; ambulances take patients to hospitals that have stroke services like Mass General, and they can notify the hospital so the doctors and nurses are ready to help when you arrive. You can request that your local medical professional contact the Pediatric Stroke and Vascular Service for consultation. They may contact the Mass General Operator at 617-726-2000 and ask to page the Child Neurology physician on call.
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.
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 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
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