Transient Ischemic Attack (TIA): A Problem Not to Miss

Background: Infections, anemia and arteriopathies are known risk factors in pediatric arterial ischemic stroke (AIS). TIAs often precede AIS in patients with arteriopathies and should be promptly recognized to prevent AIS.

Case Presentation: A 6-year-old girl known with β-thalassemia minor (β-TM) presented with acute right-sided hemiparesis and motor aphasia. She reported rhinitis, fever and reduced appetite during the previous three days. Immediate cerebral Angio-MRI showed occlusion of the left middle cerebral artery. There were no signs of ischemic infarction. The focal neurologic deficit disappeared within a few hours. Conventional angiography confirmed occlusion of the left middle and anterior cerebral artery (M1 and A1 segment) and additionally revealed stenosis of the left internal carotid artery; collaterals were present, consistent with moyamoya like arteriopathy. Laboratory investigations showed pancytopenia (Hb 58 g/L, Tc 133 G/L, Lc 2.5 G/L) in the context of an acute Parvovirus B19 infection. Anemia was treated with an EC concentrate. Prophylactic ASS therapy was installed; no further stroke-suspicious events occurred.

Discussion: Our patient suffered from a transient aplastic crisis (TAC) due to Parvovirus B19 in the context of preexisting β-TM, resulting in reduced cerebral blood flow further aggravated by the moyamoya like arteriopathy. Immediate neuroimaging followed by appropriate treatment strategies likely prevented AIS in this child.

Conclusion: This case illustrates the frequently described multifactorial etiology in pediatric arterial ischemic disease. Furthermore, it highlights the importance of immediate neuroimaging in case of acute focal neurologic deficits, especially in children with underlying hematological disorders.