The UCSF Pediatric Stroke and Cerebrovascular Group is a group of pediatric stroke neurologists and full-time support staff performing clinical research in cerebrovascular diseases, principally stroke. Its experienced research personnel include a full-time epidemiologist and biostatistician, project manager, clinical research coordinators and research analyst. The group also benefits from many dedicated research volunteers, many of whom go on to matriculate in medical and nursing schools. Dr. Heather J. Fullerton, Chief of Child Neurology serves as the director of the group and manages the numerous research studies that utilize its infrastructure. The group has monthly clinical research meetings, with video-conferencing to join investigators at its three sites (Mission Bay, Parnassus, and San Francisco General Hospital). It successfully coordinated an NIH funded multi-center clinical research, Vascular effects of Infection in Pediatric Stroke study (VIPS; PIs Heather Fullerton and Gabrielle DeVeber).  The group also has a long-standing collaboration with Kaiser Permanente Northern California, Department of Research—the Kaiser-UCSF Stroke Program (KUSP)—performing numerous epidemiological studies of adult and pediatric stroke.

STROKE

During a stroke, a blood vessel in the brain becomes blocked or bursts. Stroke is rare in children and management of the disease requires the expertise of many specialists, as well as the most advanced diagnostic and treatment approaches.

Pediatric strokes are divided into two categories: neonatal strokes, or those occurring at birth or shortly after birth, and childhood strokes.

There are two main types of strokes:

  • Ischemic Stroke — With ischemic stroke, the blood supply to the brain becomes blocked. This prevents oxygen and nutrients from reaching brain cells. Within a few minutes, these cells begin to die.
  • Hemorrhagic Stroke — With hemorrhagic stroke, a blood vessel within the brain leaks or ruptures. This is called an intracerebral hemorrhage. When this happens, blood moving into brain tissue near the hemorrhage damages cells. In children, a malformation of the blood vessels in the brain, called an arteriovenous malformation, is a common cause of intracerebral hemorrhage. In a subarachnoid hemorrhage, blood leaks under the lining of the brain. This is often caused by a small bubble on an artery known as an aneurysm.

Each child may experience symptoms of stroke differently, depending on the area of their brain that has been affected.

ANEURYSM

A brain aneurysm is a balloon or bulge in an artery where the artery wall has weakened. They're usually located on an artery at the base of the brain and typically develop where a major artery branches into smaller arteries. They can be life threatening if they burst, requiring emergency treatment.

Although most aneurysms occur in adults, they also occur in children. The cause is unknown, but some are hereditary and can affect many members of a family.

Brain aneurysms are treated at the UCSF Pediatric Stroke and Cerebrovascular Disease Center, the only comprehensive cerebrovascular disease center for children in the country, staffed by the world's leading experts in pediatric stroke and cerebrovascular disease.

ARTERIOVENOUS MALFORMATION

Arteriovenous malformations (AVMs) are abnormal tangles of arteries and veins that grow in the brain. The malformation can form wherever there are arteries or veins in the brain or spinal cord and they are the leading cause of hemorrhagic strokes in children and adolescents.

AVMs, which belong to a group of disorders known as vascular malformations, typically develop in the womb or soon after birth. Although not completely understood, they may be linked to genetic mutations.

Arteries carry oxygen-rich blood away from the heart to the body's cells and veins return oxygen-depleted blood to the lungs and heart. When AVMs disrupt this process, they can reduce the amount of oxygen received by brain tissues. This can lead to the compression of parts of the brain or spinal cord. The most severe risk of AVM is bleeding, called a hemorrhage, in the brain, which can lead to a debilitating or fatal stroke.

AVMs of the brain or spinal cord affect about 300,000 Americans. Occurring equally in males and females from all ethnic and racial backgrounds, symptoms are more common in children over 9-years-old than those who are younger.

AVMs are treated at the UCSF Pediatric Stroke and Cerebrovascular Disease Center, the only comprehensive cerebrovascular disease center for children in the country staffed by the world's leading experts in pediatric stroke and cerebrovascular disease.

MOYAMOYA

Moyamoya is a rare disorder that causes major blood vessels leading to a child's brain to narrow. If untreated, the vessels become blocked and cause a stroke or recurring mini-strokes called transient ischemic attacks (TIA). In adults, it causes bleeding in the brain or hemorrhagic strokes.

Moyamoya, first described in Japan in the 1960s, means "puff of smoke" in Japanese, named after the abnormal appearance of new blood vessels that grow to make up for the blocked artery. Although the cause is unknown, Japanese and Korean children and those with other disorders such as Down's syndrome, neurofibromatosis and tuberous sclerosis are more frequently affected.

Several types of surgery can restore blood flow to the brain. The UCSF Pediatric Stroke and Cerebrovascular Disease Center specializes in these treatments. Without treatment, the disease can be fatal.

VEIN OF GALEN MALFORMATION

Vein of Galen malformations (VOGMs) are a type of disorder known as cerebral vascular malformations, which affect the blood vessels in the brain. VOGM is a rare vascular malformation of the brain that develops before birth and is sometimes diagnosed in the womb or soon after birth.

These malformations can involve the arteries, the blood vessels that carry blood to the body, or the veins, the blood vessels that return blood to the heart. They occur occur when there is an abnormal connection between arteries and the deep draining veins.

CAVERNOUS MALFORMATION

Cavernous malformations, also called cavernous angiomas and cavernomas, belong to a group of disorders known as vascular malformations that affect the blood vessels in a child's brain. A cavernous malformation is an abnormal cluster of dilated blood vessels. This mass is made up of little pockets, called caverns, filled with blood and lined with a special layer of cells, called the endothelium. These malformations can cause children to have headache, hemorrhages, seizures and stroke symptoms.

Ranging in diameter from microscopic to inches, cavernous malformations can be located anywhere in the body including the brain, eyes, kidney, liver, nerves, rectum and spinal cord. Those that develop in the brain or spinal cord, called cerebral cavernous malformations (CCM), are the most serious.