Children's Hospital Colorado

Researchers at Children's Hospital Colorado Investigate the Causes of Stroke in Children

Why Do Kids Have Strokes?

Pediatric stroke survivor Sam eats gelato with his doctors at Children's Hospital Colorado.
Pediatric stroke survivor Sam Mattei, 11, eats gelato with Drs. Bernard (right), Armstrong-Wells and Goldenberg (far left).

Sam Mattei is an 11-year-old: he plays football and basketball, juggles piano lessons and boy scouts, outgrows his jeans almost as soon as he gets them, and denies affection for an admiring younger brother.

Sam Mattei is a typical 11-year-old, but his story is rare. After a closer look you see it in his eyes, how he carries himself, what his dad calls a "personality change." See, when Sam was six, he had a stroke - a condition so common in adults, so familiar, that it takes a moment to grasp its bizarre occurrence in children.

"Kids don't have strokes," said Marty Mattei, Sam's dad, recalling his disbelief when doctors diagnosed Sam's dizzy spell on the ski slope as a stroke.

It seems unfitting that Sam, an otherwise healthy boy, suffered a stroke. His two younger brothers never had one, his parents never had one. So how did Sam have one?

What causes stroke in children?

"We don't know what causes pediatric stroke," said Jennifer Armstrong-Wells, MD, MPH, neurology, assistant professor of pediatrics and director of the Perinatal and Hemorrhage Stroke Program. "At this time, most theories are speculative."

Armstrong-Wells and her Children's colleagues Neil Goldenberg, MD, PhD, assistant professor of pediatrics and medicine and co-director of the Colorado Pediatric Stroke Program and Timothy Bernard, MD, assistant professor of pediatrics and co-director of the Colorado Pediatric Stroke Program are conducting unprecedented basic, clinical and translational research to find out why and how kids like Sam have a stroke. Their newest research will improve care for children who once had no hope of survival.

Under the mentorship of Dr. Goldenberg and seasoned researcher Marilyn Manco-Johnson, MD, professor of pediatrics and associate professor of pathology and director of the University of Colorado Hemophilia and Thrombosis Center, Drs. Bernard and Armstrong-Wells are actively investigating a condition familiar in adults but still mysterious among children.

Researching the what, why and when of pediatric stroke

2009 marked a banner year for Drs. Armstrong-Wells, Bernard, and Goldenberg, as they forged a new path in identifying predictors of pediatric stroke and its outcome for children.

All four investigators are currently studying prognostic factors in pediatric vascular disease. In particular, they are investigating biomarkers - biological indicators of vulnerability and risk.

Until now, biomarkers research has gone widely neglected, partly because the pediatric stroke field is still in its infancy. As such, Drs. Bernard, Goldenberg, Armstrong-Wells and Manco-Johnson believe the time is right to systematically study predictors and outcomes.

Their research addresses deficiencies to more precisely define and treat pediatric stroke. Such deficiencies include identifying the anatomical causes of stroke, establishing a standardized system of categorization, implementing a standardized physical exam to characterize stroke severity, evaluating laboratory markers of clotting and inflammation, and "risk-stratification" (that is, using this information to develop treatment approaches better tailored to a child's risk of second stroke and prospects for neurological recovery).

In other words, they want to know why certain kids experience stroke, pinpoint its origin, assess its severity and determine how the future might look for each stroke patient.

They hope their research will identify kids like Sam, intervening early in its course or even before the stroke occurs.

To achieve this, Drs. Bernard, Goldenberg, Armstrong-Wells and Manco-Johnson will continue to invite families like the Mattei's to participate in comprehensive studies and share with them findings that could change future patient care.

Children's stands out among stroke research centers

"In 2009, we really have established ourselves as one of the leading pediatric stroke centers in the U.S. for clinical care and research," said Dr. Goldenberg. "We've improved and systemized care while engaging in research."

Children's owes much of its success in pediatric stroke research and care to its University of Colorado School of Medicine affiliation and collaboration with the Hemophilia and Thrombosis Center.

"This level of research could not be possible without it," said Dr. Goldenberg, explaining the importance of database experts, research nurses, and laboratory specialists, all housed at the University of Colorado Hemophilia and Thrombosis Center. "It's a collaboration to enhance Children's research abilities."

Its location on the Anschutz Medical Campus accounts for many of Children's successful research projects, as it's equipped with state-of-the-art facilities and experts in several disciplines. Because of the complex nature of pediatric stroke, Children's patients benefit greatly from this comprehensive setting.

"I couldn't have asked for a better care experience," said Mattei. "It's had a profound effect on our lives. I feel very positive that Sam's going to lead a very healthy and productive life."

Sam is an 11-year-old who just wants to be a kid, excited for gelato, bored by adults. These days, Sam is more reserved - that personality change his dad described - but he isn't scared. After five years of care at Children's Hospital Colorado Pediatric Stroke Program (TCHPSP), he has recovered from the one-time event, safe in the hands of world-class researchers.


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