A Brief Introduction to Stroke across the Lifespan

Danielle Ploetz, PhD, ABPP • Kelly Jones, PhD, ABPP

Stroke occurs when oxygen supply to the brain is suddenly interrupted or reduced. Without sufficient oxygen, cells in the brain begin to die, resulting in reduced functioning of that part of the brain. Stroke can be classified as ischemic (insufficient blood flow to brain) or hemorrhagic (rupture of blood vessels).

Stroke is the second leading cause of death worldwide and affects individuals across the lifespan. In the United States, 795,000 people have a stroke per year with 75% of those occurring in individuals over the age of 65. Ischemic and hemorrhagic stroke are equally common in children but ischemic stroke is far more common in adults (about 88%).1 The incidence of perinatal stroke ranges from 1 in 1,100 to 3500 full-term births. Perinatal stroke occurs between 20 weeks gestation through the first 28 days of life and is one of the most common causes of cerebral palsy.2

Etiology differs for children and adults. For ischemic stroke, risk factors for children include cardiac disease, infection, and brain artery disease (e.g., sickle cell disease) and risk factors for adults include age, hypertension, atrial fibrillation, drug use, and obesity.2 Hemorrhagic stroke most often results from aneurysm or hypertension in adults while childhood hemorrhagic stroke most often results from trauma (e.g., TBI), intracranial abnormalities (e.g., AVM rupture), and brain tumors.2 Psychosocial factors, including low socioeconomic status, non-white race, and female gender are also associated with increased risk of stroke.1

Improving lifestyle factors such as nutrition, exercise, sleep, and stress are central in preventing stroke in adulthood. Identifying and managing risk factors such as high blood pressure, high cholesterol, and diabetes are also important. For children, routine medical and neurodevelopmental follow-up for conditions with increased risk of stroke (e.g., sickle cell disease, congenital heart disease) are essential. Early identification of stroke is crucial in preventing longterm disability and death. 3

Depending on the location in the brain, stroke can cause changes in motor (e.g., hemiplegia), speech (e.g., aphasia), thinking (e.g., attention, memory, hemispatial neglect), and/or emotional functioning. Rehabilitation treatment plans are designed based on the individual’s unique combination of deficits. It is important to receive interdisciplinary care including neurology, rehabilitation medicine, neuropsychology, and rehabilitation therapies to optimize recovery of function. Rehabilitation following stroke may include medication management, physical activities, communication-focused therapy, cognitive rehabilitation, and emotional support (e.g., psychotherapy). Constraint-induced movement therapy (CIMT) is also frequently used for children and adults to address resulting hemiplegia. More recently, advances in technology has expanded therapeutic options. Initiatives to increase awareness of stroke have led to earlier identification and treatment, resulting in reduced mortality and improved outcomes.

References

1. Stroke Facts | cdc.gov. Published September 9, 2020. Accessed February 26, 2021. https://www.cdc.gov/ stroke/facts.htm 2. Stucky K, Kirkwood M, Donders J, eds. Clinical Neuropsychology Study Guide and Board Review. 2nd ed. Oxford; 2020. 3. Virani Salim S., Alonso Alvaro, Benjamin Emelia J., et al. Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association. Circulation. 2020;141(9):e139-e596. doi:10.1161 CIR.0000000000000757

Author Bios

Danielle Ploetz, PhD, ABPP earned her Ph.D. at the University of South Alabama in a combined and integrated clinical/counseling psychology program. She completed her pre-doctoral internship at the University of Florida Health Sciences Center with a focus in neuropsychology and completed a post-doctoral fellowship in pediatric neuropsychology at the Alberta Children’s Hospital in Calgary, AB Canada. Dr. Ploetz joined the Kennedy Krieger Institute in 2015 and is board certified in clinical neuropsychology. Currently, Dr. Ploetz is the neuropsychologist for the Specialized Transition Program (STP), the Kennedy Krieger Institute’s day rehabilitation hospital within the Fairmount Rehabilitation Programs and works in the interdisciplinary concussion clinic.

Kelly Jones, PhD, ABPP earned her doctoral degree in Clinical Psychology with a specialization in Neuropsychology from Drexel University and completed a post-doctoral fellowship in pediatric neuropsychology at the Kennedy Krieger Institute/Johns Hopkins University School of Medicine. Dr. Jones is a licensed psychologist and board certified clinical neuropsychologist at the Kennedy Krieger Institute. She provides neuropsychological services to children throughout Kennedy Krieger Institute’s Rehabilitation Continuum of Care, including the inpatient neurorehabilitation unit, concussion clinic, and multidisciplinary brain injury clinic.