Neuropediatrics 2012; 43 - PS15_06
DOI: 10.1055/s-0032-1307115

Cerebellar Infarction and Coarctation of the Aorta – causal relation or coincidence?

A Bertsche 1, S Syrbe 1, M Bernhard 1, C Schober 1, W Siekmeyer 1, S Wygoda 2, T Hantel 3, D Fritzsch 4, A Merkenschlager 1
  • 1Universitätsklinik und Poliklinik für Kinder und Jugendliche, Leipzig, Germany
  • 2Klinikum St. Georg gGmbH, Klinik f. Kinder u. Jugendliche, KfH Nierenzentrum für Kinder und Jugendliche, , Leipzig, Germany
  • 3Klinikum St. Georg gGmbH, Abteilung Neuroradiologie, Leipzig, Germany
  • 4Universitätsklinikum Leipzig, Abteilung Neuroradiologie, Leipzig, Germany

Aims: Description of a child with ischemic cerebellar infarction and coarctation of the aorta.

Methods: Case report

Results: An almost 5 year old boy with unremarkable medical history suffered from vomiting, dizziness, and eventually unsteadiness of gait. Four days after these acute symptoms the patient was admitted at another hospital. The examination revealed a gait deviation to the left and a pronounced dysmetria of the left upper limb. The cranial MRI showed disturbed diffusion in the left cerebellar hemisphere with a T2 -hyerintensity measuring 1.5×2.4×3.5cm and a weak contrast enhancement. Additionally, the patient had an arterial hypertonus. Echocardiography was performed at the other hospital, no cause of cerebral ischemia or arterial hypertonus was found. Because of blood pressure peaks up to 160/100 mmgHg enalapril was started. ASS was added to prevent reocclusion. Detailed thrombophilia tests solely showed an elevation of Lp(a). Varicella titer and a screening for inborn errors of metabolism were unremarkable. The patient was admitted to our clinic for digital substraction angiography (DSA) to search for a vertebral artery dissection as a possible consequence of the arterial hypertonus or a fibromuscular dysplasia causing the hypertonus. DSA showed a tight coarctation of the aorta without stenosis of the left subclavian artery. The coarctation of the aorta was treated by balloon dilatation angioplasty.

Conclusion: We discuss the coarctation of the aorta as cause of the cerebellar infarction. In the (scientific) literature, a 5 year old child is described with coarctation of the aorta and cerebellar infarction. In contrast to our patient the child had a marked stenosis of the left subclavian artery. Reports of cerebellar infarction in unoperated coarctation of the aorta without stenosis of the subclavian artery cannot be found so far. In our case probably the combination of coarctation of the aorta and elevation of Lp(a) induced the cerebellar infarction.

Cerebellar infarction - coarctation of the aorta