Download PDF
Journal of Pediatric Neurology 2021; 19(06): 446-448
DOI: 10.1055/s-0041-1722928
Case Report

Acute Ischemic Stroke in a 10-Month-Old Baby Recovered With Aspirin

Seyed A. Hosseini
1   Department of Pediatrics, Golestan University of Medical Sciences, Taleghani Hospital of Gorgan, Golestan, Iran
,
Mohammad H. Gharib
2   Department of Radiology, Golestan University of Medical Sciences, Taleghani Hospital of Gorgan, Golestan, Iran
,
Seyed B. Mirheidari 
3   Department of Medicine, Golestan University of Medical Sciences, Taleghani Hospital of Gorgan, Golestan, Iran
,
Bahar Ghanbarzade
4   Golestan University of Medical Sciences, Taleghani Hospital of Gorgan, Golestan, Iran
,
Parnian S. Hosseini
3   Department of Medicine, Golestan University of Medical Sciences, Taleghani Hospital of Gorgan, Golestan, Iran
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Acute ischemic stroke is rare in children and often brings enduring and permanent morbidity in pediatric population. While there are numerous recommendations for initial treatment, evidence on effectiveness of different therapies among children is limited. Here, we describe a 10-month-old male child patient who presented with fever, restlessness, seizure and postictal left limb weakness. Examination revealed left hemiplegia and hemiparesthesia. Computed tomography (CT) head showed loss of gray–white matter distinction with diffuse hypodensity in the right temporoparietal lobes and right caudate nucleus. Magnetic resonance imaging (MRI) brain demonstrated diffusion restriction in favor of acute ischemic stroke in the right middle cerebral artery (MCA) territory. Brain MR angiography (MRA) demonstrated complete occlusion of proximal aspect of M1 segment of right MCA. Genetic testing determined a homozygous 4G/4G polymorphism of the PAI-1 gene. Antiplatelet therapy was started after diagnosis and continued for 8 days with antibiotic therapy. Stroke in children and infants is an infrequent condition associated with substantial morbidity and mortality that needs clinicians' care. This case highlights the significance of awareness about stroke in children and emphasizes on further research to compile evidence-based guidelines for acute stroke therapy in children.

Keywords

acute ischemic stroke - infancy - seizure - hemiplegia


Publication History

Received: 14 November 2020

Accepted: 21 December 2020

Article published online:
17 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Dlamini N, deVeber G. Pediatric stroke. In: Kliegman RM, Geme St. JW, Blum NJ. et al eds. Nelson Textbook of Pediatrics. 21st ed.. Elsevier; 2019: 12479-12480
    Google Scholar
  • 2 Mallick AA, Ganesan V, Kirkham FJ. et al. Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study. Lancet Neurol 2014; 13 (01) 35-43
    CrossrefPubMedGoogle Scholar
  • 3 Earley CJ, Kittner SJ, Feeser BR. et al. Stroke in children and sickle-cell disease: Baltimore-Washington Cooperative Young Stroke Study. Neurology 1998; 51 (01) 169-176
    CrossrefPubMedGoogle Scholar
  • 4 Carvalho KS, Garg BP. Arterial strokes in children. Neurol Clin 2002; 20 (04) 1079-1100
    CrossrefPubMedGoogle Scholar
  • 5 Rivkin MJ, deVeber G, Ichord RN. et al. Thrombolysis in pediatric stroke study. Stroke 2015; 46 (03) 880-885
    CrossrefPubMedGoogle Scholar
  • 6 Royal College of Pediatrics and Child Health. Stroke in childhood: clinical guidelines for diagnosis, management and rehabilitation. Available at: Accessed January 11, 2021 https://www.rcpch.ac.uk/resources/stroke-childhood-clinical-guideline-diagnosis-management-rehabilitation
    PubMedGoogle Scholar
  • 7 Bansal S, Sangha KS, Khatri P. Drug treatment of acute ischemic stroke. Am J Cardiovasc Drugs 2013; 13 (01) 57-69
    CrossrefPubMedGoogle Scholar
  • 8 Bernard TJ, Goldenberg NA, Armstrong-Wells J, Amlie-Lefond C, Fullerton HJ. Treatment of childhood arterial ischemic stroke. Ann Neurol 2008; 63 (06) 679-696
    CrossrefPubMedGoogle Scholar
  • 9 Kirkman MA, Citerio G, Smith M. The intensive care management of acute ischemic stroke: an overview. Intensive Care Med 2014; 40 (05) 640-653
    CrossrefPubMedGoogle Scholar
  • 10 Ferriero DM, Fullerton HJ, Bernard TJ. et al; American Heart Association Stroke Council and Council on Cardiovascular and Stroke Nursing. Management of stroke in neonates and children: a scientific statement from the American Heart Association/American Stroke Association. Stroke 2019; 50 (03) e51-e96
    CrossrefPubMedGoogle Scholar
  • 11 Souto Silva R, Rodrigues R, Reis Monteiro D. et al. Acute ischemic stroke in a child successfully treated with thrombolytic therapy and mechanical thrombectomy. Case Rep Neurol 2019; 11 (01) 47-52
    CrossrefPubMedGoogle Scholar
  • 12 Abend NS, Beslow LA, Smith SE. et al. Seizures as a presenting symptom of acute arterial ischemic stroke in childhood. J Pediatr 2011; 159 (03) 479-483
    CrossrefPubMedGoogle Scholar