Time Is Brain: Thrombectomy after Pediatric Stroke in Two Previously Healthy Girls
26 April 2017 (online)
Background: Pediatric stroke patients arrive in hospital usually too late for invasive therapy (lysis or thrombectomy). We report two cases from our pediatric center, where mechanical thrombectomy was successfully performed due to the short time delay (<4.5 hours) from beginning of symptoms until the neuroradiologic intervention.
Case Reports: Case 1: An 11-year-old girl presented in our emergency department with acute motor aphasia and right-sided facial palsy. Urgent MRI revealed subtotal M1 media occlusion on the left side, confirmed by catheter angiography. In the same procedure (3.5 hours after beginning of symptoms), thrombectomy was performed. Clinical symptoms resolved completely after the intervention. There was no persistent foramen ovale. Thrombophilia was diagnosed with homozygous MTHFR and PAI mutations. Case 2: A 15-year-old girl with fluctuating right-sided hemiparesis and facial paresis, motoric aphasia, and disturbance of consciousness. She was presented to the children’s hospital in Esslingen, then transferred to us as an emergency. Urgent MRI revealed complete M1 media occlusion on the left side. Endovascular aspiration thrombectomy was performed 4 hours after beginning of symptoms. Echocardiography showed a persistent foramen ovale. Results from thrombophilia screening are pending.
Results: Our case reports show the feasibility of mechanical thrombectomy in pediatric stroke, if patients are presented in the center timely. The intervention can result in rapid and complete remission of neurologic symptoms.
Conclusion: Interdisciplinary close and rapid teamwork between referring physician, pediatric neurology, pediatric radiology, neuroradiology, pediatric hemostaseology, and pediatric intensive care are necessary for the diagnosis and treatment of pediatric stroke.