Maternal alert system

Mother’s Day 2025 is one holiday Chrissy Panzner won’t soon forget.

That was the day when her daughter, Samantha, a fun-loving 5-year-old, suffered a stroke.

“Two of my kids were playing around at home and the next thing we knew, one of them was crying,” recalled Panzner, a mother of three. “My husband went to Sammy’s room to check on her and saw that she was holding her right arm a little funny.”

Panzner initially thought her daughter was exhibiting “nursemaid elbow,” a partial dislocation injury common among children younger than 5, which Sammy had experienced in the past.

But then Panzner, a licensed clinical social worker, noticed that her daughter was acting a little confused and her speech was off. At that point, she decided to take Sammy to the Wolfson Children’s Town Center Emergency Center to get evaluated for a concussion.

Seeing all the signs

At the ER, Sammy had a CT scan, which came back negative for a head injury. She then underwent a medical procedure to see whether she could eat and drink without vomiting.

“During this time, Sammy was having difficulty staying awake,” Panzner said. “I told her we could go home if she would just eat and drink something. While she was eating her goldfish crackers, I noticed she wasn't using her right hand.”

That’s when Panzner’s clinical assessment training kicked in. She asked her daughter to pronounce the word “mom,” followed by the names of her siblings.

“At that point, her speech was just word salad,” Panzner added. “I didn’t want to catastrophize the situation, but it looked to me like she was having a stroke.”

Code stroke activated

According to researchers, children and adolescents experience the same types of strokes as adults, although their symptoms are often more subtle and challenging to diagnose. While CT scans can detect strokes, imaging may come back “normal” shortly after the stroke occurs, as was the case with Sammy.

After Panzner relayed her suspicions to the ER staff, the pediatric emergency medicine specialist noted Sammy’s worsening symptoms and activated a Code Stroke, a protocol for urgent stroke assessment and treatment.

She was rushed by ambulance to Wolfson Children’s Hospital, where an MRI exam confirmed that she had suffered an ischemic stroke, which occurs when blood flow to the brain is blocked, often due to a clot.

“Once Sammy was admitted to the Pediatric Intensive Care Unit, her face drooping was more pronounced, and she couldn’t sit up, speak or swallow,” Panzner said.

Many adults who experience an ischemic stroke are treated with the clot-busting drug tPA within a few hours after onset. But the powerful blood-thinner has not been FDA-approved for use in children. For that reason, Sammy’s pediatric neurologist, Rodolfo Lewy, MD, of Nemours Children’s Health, decided not to administer tPA.

“Due to how deep the clot was, the doctors also weren’t able to perform a surgical intervention without damaging her brain,” Panzner said.

Stroke of unknown origin

Doctors determined Sammy had a slow-progressing stroke without a known cause, also known as a cryptogenic stroke. According to the American Stroke Association, one in three ischemic strokes are cryptogenic, and these types of strokes are often linked to undetected heart conditions.

A small percentage of strokes in children and adolescents are attributable to a common congenital heart defect known as a patent foramen ovale (PFO), an opening in the heart’s upper chambers that doesn’t close naturally after birth. Dr. Lewy scheduled a transthoracic echocardiogram, a non-invasive ultrasound procedure that evaluates heart function and potential disease, to rule that out. The exam came back negative.

“Looking back at all her behaviors, it’s very possible the stroke started at home,” Panzner said. “Sammy still has a hard time using her right hand, but her deficits could have been a lot worse had we not gone to the ER when we did.”

Sharing her successes

Sammy spent 10 days in Wolfson Children’s Borowy Family Children’s Critical Care Tower followed by seven weeks as an inpatient at Brooks Rehabilitation, where she underwent intensive speech and physical therapy. During her short stay at Wolfson Children’s, Sammy participated in Art with a Heart projects, was introduced to adaptive golf, and made several visits to the Children’s Chapel, where she met “Jude,” Wolfson Children’s inaugural facility dog and a founding member of “Wolfie’s Woofpack.”

“After going through such a stressful situation, we were blessed to be in this hub of pediatric care,” Panzner said. “Sammy missed a lot of school because of her lengthy rehab, but she’s back on track to graduate the first grade, and it’s important to share her successes and her story because life-threatening medical conditions like a stroke can happen to kids.”

A stroke is a life-threatening emergency. If you or someone else has symptoms of a stroke, call 911 immediately. The pediatric neurology and neurosurgery teams with Wolfson Children’s Stys Neuroscience Institute diagnose and treat a wide range of brain conditions. To learn more, visit wolfsonchildrens.com/neuro.