First thrombolysis in a 2-year-old child with ischemic stroke at HC FMUSP: case report

Case presentation: Female patient, 2 years and 3 months old, previously followed up by pediatric cardiology due to complex congenital heart disease characterized by pulmonary atresia and intact interventricular septum and atrial septal defect with important right-to-left shunt in the late postoperative period of blalock surgery taussig modified on 04/30/2020 and Glenn's surgery on 04/26/2021. Child was referred to pediatric neurology on 8/16/2022 due to complete left hemiparesis and ictal anarthria, at evaluation around 3 hours after the onset of the event scored on the NIHSS 11 scale (Item 4: 2 points | Item 5a: 4 points |Item 6a: 3 points | Item 10: 2 points), performed CT of the skull that showed ischemia of the caudate nucleus, lentiform and right internal capsule, estimated ASPECTS of 8. Talked with parents and explained about the lack of consensus, possible adverse and beneficial effects of thrombolysis with intravenous alteplase, after discussion between the assistant teams together with those responsible for the child, thrombolysis was indicated, which was performed three hours and thirty minutes after the event, with an improvement in the NIHSS to 6 (Item 4: 0 point | Item 5a: 3 points | Item 6a: 2 points | Item 10: 1 point) and no evidence of CNS bleeding after control neuroimaging.

Discussion: Despite the higher incidence of stroke in the population over 18 years of age, in the pediatric age group, data around 5 to 10 for every 100,000 children annually have been reported, with mortality around 6% and of those who survive, around 75% have sequelae neurological signs that impair the quality of life and development of these children. The treatment of the acute phase in cases of ischemic stroke is very well studied and conducted in adult patients, but in the pediatric age group there are few published studies with a small number of patients who underwent reperfusion therapies, in view of this, to date, there is no there are well-established guidelines on the subject.

Final comments: We highlight the important relevance of the report of this pioneering case in thrombolysis in a 2-year-old child with a favorable clinical outcome, to open more discussions regarding the indication of vascular reperfusion therapies in the pediatric age group.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
18 September 2023