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Brincau-García FJ, López-Pequeño J, Ruiz-Martín Y, Chacón-Pascual A, Vázquez-López M. Mineralizing angiopathy as a rare cause of pediatric stroke: review and report of two cases. Childs Nerv Syst 2024:10.1007/s00381-024-06548-9. [PMID: 39060748 DOI: 10.1007/s00381-024-06548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
In the Indian subcontinent, traumatic brain injury stands as the leading cause of pediatric stroke, whereas in Europe, it is considered a rare or potentially underdiagnosed factor. The etiology of post-traumatic stroke is unknown, although it has been associated with the presence of calcification in the lenticulostriate arteries, a condition known as "mineralizing angiopathy." The theory suggests that calcified lenticulostriate vessels in a brain with inadequate myelination could have an increased vulnerability to mechanical injuries, which may result in their obstruction. This ischemic stroke associated with mineralizing angiopathy usually occurs after mild traumatic brain injury, with an asymptomatic interval following the trauma. The typical age of presentation is between 6 and 24 months. Children with mineralizing lenticulostriate vasculopathy generally experience a favorable outcome after stroke, with the majority achieving complete or nearly complete recovery of their motor functions. Despite aspirin treatment, a small proportion of children may still face stroke recurrence following repeat head trauma. We present the cases of two male patients with clinical features compatible with childhood stroke after a mild traumatic brain injury.
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Affiliation(s)
| | | | - Yolanda Ruiz-Martín
- Pediatric Radiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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2
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Gader G, Masmoudi M, Ghedira K, Krifa MI, Chelly I, Zammel I, Badri M. Lumbar spine epidural meningioma: report of a rare case. Spinal Cord Ser Cases 2023; 9:53. [PMID: 37907495 PMCID: PMC10618258 DOI: 10.1038/s41394-023-00608-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Spinal meningiomas are typically intradural lesions. Some may infiltrate the dura mater, thus exhibit direct extradural extension. Pure spinal epidural meningiomas are very rare. Here we present a 64 year-old-male with a purely extradural meningioma, and reviewed 15 previously reported cases from the literature. CASE PRESENTATION AND CLINICAL DISCUSSION A 64-year-old male presented with a progressive cauda equine syndrome. When Lumbar spine MRI showed two extradural lesions regarding the L3-L4 level, one was fully removed (i.e., the posterolateral lesion), while the other anterior lesion was left alone (i.e., to avoid potential neurologic sequelae). Pathologically, the lesion was a benign meningioma. CONCLUSIONS Spinal epidural meningiomas are rare and should optimally be fully excised at the index surgery.
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Affiliation(s)
- Ghassen Gader
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia.
| | - Mourad Masmoudi
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia
| | - Khalil Ghedira
- Department of Neurosurgery, National Institute of Neurology, Tunis, Tunisia
| | | | - Ines Chelly
- Department of Pathology, La Rabta Hospital, Tunis, Tunisia
| | - Ihsèn Zammel
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia
| | - Mohamed Badri
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia
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3
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Moon S, Park JE, Jung DE, Kim JH. Minor Head Injury-Induced Striatocapsular Infarction in a 3-Year-Old Girl. J Emerg Med 2023; 65:1-4. [PMID: 37474345 DOI: 10.1016/j.jemermed.2023.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Sowon Moon
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Ji Eun Park
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Da Eun Jung
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Jung Heon Kim
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea.
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Yanes FB, Birriel F, Rabelino GG. Basal Ganglia Stroke after Mild Traumatic Brain Injury in Mineralizing Lenticulostriate Vasculopathy. JOURNAL OF PEDIATRIC NEUROLOGY 2023. [DOI: 10.1055/s-0043-1761486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AbstractAlthough the association between basal ganglia (BG) stroke and mild traumatic brain injury (TBI) is well recognized, its association with lenticulostriate vasculopathy has only recently been described. We present the case of a 6-month-old female infant without personal or familiar relevant records who presented with left-sided hemiparesis and without altered consciousness after a mild TBI. An emergency computed tomography (CT) scan of the brain revealed bilateral linear calcifications along the course of the lenticulostriate arteries. Brain magnetic resonance imaging (MRI) revealed an ischemic lesion in the right BG and damage to the posterior limb of the right internal capsule. A few months after the ischemic event, the patient was asymptomatic. Given the clinical, radiological, and evolutionary characteristics of this group of patients, the term mineralizing angiopathy is proposed to define a specific clinical-imaging syndrome in infants who suffer a BG stroke after a mild TBI and present with the calcification of the lenticulostriate arteries.
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Affiliation(s)
| | - Florencia Birriel
- Medical Imaging, Medica Uruguaya Corporación de Asistencia Medica, Uruguay
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5
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Wang G, Liang J, Xin C, Wang L, Wu X. Association of Cytomegalovirus Infection with Lenticulostriate Stroke After Mild Head Trauma in Young Children. J Child Neurol 2022; 37:922-926. [PMID: 35118892 DOI: 10.1177/08830738221077756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The development of lenticulostriate stroke following mild head trauma accounts for 3% of traumatic brain injuries in children. Nevertheless, the pathogenesis of infantile lenticulostriate stroke with lenticulostriate calcification is poorly understood. In this study, we explored the association of a recent viral infection with the development of infantile lenticulostriate stroke with lenticulostriate calcification following mild head trauma in children. We examined the records for 49 children (<36 months old) diagnosed with infantile stroke following mild head trauma at the First Hospital of Jilin University between January 2007 and August 2019. The demographic characteristics, clinical manifestations, and laboratory and imaging results were collected and analyzed. Antibodies against Epstein-Barr virus, herpes simplex virus, and cytomegalovirus in the patient sera were assessed. A total of 18 patients with lenticulostriate stroke and calcification were included in the Patient group (16.61 ± 10.57 months), and 14 patients without calcification were included in the Control group (13.07 ± 7.66 months). Imaging findings demonstrated the presence of lenticulostriate stroke in all patients. There were no significant differences in the demographic characteristics or clinical manifestations of stroke between both groups (P > .05). Similarly, no significant differences were observed in the Epstein-Barr virus and herpes simplex virus-1 antibody positivity in both groups. In contrast, cytomegalovirus antibody was significantly more abundant in the Patient group (P < .05). All patients were hospitalized for conservative treatment with favorable prognoses. Our results suggest that cytomegalovirus infection may be associated with the development of lenticulostriate strokes in pediatric patients following minor head injury.
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Affiliation(s)
- Guangming Wang
- Department of Neurosurgery, 117971First Hospital of Jilin University, Changchun, China
| | - Jianmin Liang
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun, China.,Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China
| | - Cuijuan Xin
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun, China
| | - Linyun Wang
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun, China
| | - Xuemei Wu
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun, China.,Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China
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6
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Tan MA, Layug EJV, Singh BP, Parakh M. Diagnosis of Pediatric Stroke in Resource Limited Settings. Semin Pediatr Neurol 2022; 44:100997. [PMID: 36456040 DOI: 10.1016/j.spen.2022.100997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 10/14/2022]
Abstract
Global awareness of stroke as a significant cause of neurologic sequelae and death in children has increased over the years as more data in this field becomes available. However, most published literature on pediatric stroke have limited geographic representation. Data on childhood stroke from developing countries remains limited. Thus, this paper reviewed geographic/ethnic differences in pediatric stroke risk factors highlighting those reported in low- and middle-income countries, and proposes a childhood arterial ischemic stroke diagnostic algorithm for resource limited settings. Stroke risk factors include cardiac disorders, infectious diseases, cerebral arteriopathies, hematologic disorders, inflammatory diseases, thrombophilia and genetic conditions. Infection of the central nervous system particularly tuberculous meningitis, is a leading cause of pediatric arterial ischemic stroke in developing countries. Stroke should be considered in children with acute focal neurologic deficit especially in the presence of aforementioned risk factors. Cranial magnetic resonance imaging with angiography is the neuroimaging modality of choice but if unavailable, cranial computed tomography with angiography may be performed as an alternative. If both are not available, transcranial doppler together with neurologic exam may be used to screen children for arterial ischemic stroke. Etiological diagnosis follows with the aid of appropriate laboratory tests that are available in each level of care. International collaborative research on stroke risk factors that are prevalent in low and middle income countries will provide information for drafting of stroke care guidelines that are universal yet inclusive taking into consideration regional differences in available resources with the goal of reducing global stroke burden.
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Affiliation(s)
- Marilyn A Tan
- Division of Pediatric Neurology, Departments of Pediatrics and Neurosciences, University of the Philippines - Philippine General Hospital, Manila, Philippines.
| | - Elbert John V Layug
- Division of Pediatric Neurology, Departments of Pediatrics and Neurosciences, University of the Philippines - Philippine General Hospital, Manila, Philippines
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Sugumar K, Chidambaram AC, Deepthi B, Krishnamurthy S, Delhikumar CG. A rare cause of stroke in young children: minor head trauma associated with mineralising lenticulostriate angiopathy in three patients. Paediatr Int Child Health 2022; 42:67-71. [PMID: 35471857 DOI: 10.1080/20469047.2022.2066386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Acute basal ganglia infarct following minor head trauma in association with mineralisation of lenticulostriate arteries is an increasingly recognised entity in childhood stroke. Three cases with a classical history and phenotypical features of mineralising angiopathy are described. Case 1 was a 2-year-old girl who presented with acute onset hemiparesis with a same-side upper motor neuron (UMN)-type facial palsy following minor head trauma. Case 2 was a 14-month-old boy who presented with a left side hemiparesis and a left UMN-type facial nerve palsy following a minor fall. Case 3 was an 8-month-old boy who, following a fall from his cot, had a sudden-onset hemiparesis on the right side and deviation of the angle of the mouth to the left. In brain computed tomography, all three cases demonstrated characteristic basal ganglia calcification of the mineralising angiopathy. Magnetic resonance imaging of the brain demonstrated features supportive of acute infarcts in the lentiform nucleus, caudate nucleus and putamen. Two of the patients had iron deficiency anaemia with haemoglobin of 7.0 g/dL and 7.8 g/dL, respectively. On follow-up, Case 1 had mild residual weakness and the other two made a complete recovery. None of the patients had a recurrence of stroke. Basal ganglia stroke with mineralising angiopathy should be considered in toddlers presenting with sudden-onset focal neurological deficits preceded by minor head trauma.Abbreviations: ADC: apparent diffusion coefficient; CT: computed tomography; DWI: diffusion-weighted imaging; Hb: haemoglobin; IDA: iron deficiency anaemia; MRI: magnetic resonance imaging; SLV: sonographic lenticulostriate vasculopathy; SWI: susceptibility weighted imaging; UMN: upper motor neuron.
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Affiliation(s)
- Kiruthiga Sugumar
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Aakash Chandran Chidambaram
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Bobbity Deepthi
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sriram Krishnamurthy
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - C G Delhikumar
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Kamate M, Goudar N, Detroja M. Role of Antiplatelet Therapy in Pediatric Stroke with Mineralizing Angiopathy. Indian J Pediatr 2021; 88:1152. [PMID: 34363184 DOI: 10.1007/s12098-021-03909-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Mahesh Kamate
- Department of Pediatric Neurology, KAHER's Jawaharlal Nehru Medical College, Belagavi, Karnataka, 590010, India.
| | - Neha Goudar
- Department of Pediatric Neurology, KAHER's Jawaharlal Nehru Medical College, Belagavi, Karnataka, 590010, India
| | - Mayank Detroja
- Department of Pediatric Neurology, KAHER's Jawaharlal Nehru Medical College, Belagavi, Karnataka, 590010, India
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Goraya JS, Berry S, Kaur A, Singh G. Arterial Ischemic Stroke-Peculiarities of Clinical Presentation and Risk Factors in Indian Children. Neuropediatrics 2021; 52:294-301. [PMID: 34102685 DOI: 10.1055/s-0041-1728773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There are not enough recent studies on arterial ischemic stroke (AIS) in Indian children. We retrospectively reviewed data on 95 children (69 boys), aged 3 months to 17 years, with AIS. Focal signs were noted in 84 (88%) with hemiparesis in 72 (76%). Diffuse signs were present in 33 (35%) with fever in 22 (23%), altered mental status in 20 (21%), and headache in 12 (13%). Seizures occurred in 29 (31%) children. Arteriopathy was observed in 57 (60%) children with mineralizing lenticulostriate vasculopathy (mLSV) in 22 (23%) being the most common, followed by moyamoya in 14 (15%), arterial dissection in 9 (10%), and focal cerebral arteriopathy (FCA) in 8 (8%). Preceding head/neck trauma was present in 27 (28%) children: 23 had minor head trauma (MHT), 3 neck trauma, and 1 unspecified. Other common risk factors (RFs) were iron deficiency in 10 children, homocysteinemia in 8 children, and tuberculous meningitis in 5 children. Complete or nearly complete recovery occurred in 42 (44%). Nine children developed epilepsy and five cognitive and language disability. Stroke recurrences occurred in nine children. Overall, arteriopathies accounted for majority of the cases of childhood AIS in our study with mLSV and moyamoya being the most frequent. Compared with data from Western countries, FCAs, postvaricella arteriopathy, and arterial dissections were less common. Of the nonarteriopathic RFs, MHT, iron deficiency, homocysteinemia, and neuroinfections were most frequent in our cohort in contrast to cardioembolic diseases and inherited procoagulant conditions, which are common in developed countries.
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Affiliation(s)
- Jatinder Singh Goraya
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Shivankshi Berry
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Amandeep Kaur
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Gagandeep Singh
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
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10
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Guo MH, Beslow LA. Basal ganglia calcifications-etiological relationship to strokes from mild head trauma? Eur J Paediatr Neurol 2021; 33:A3-A4. [PMID: 34247930 DOI: 10.1016/j.ejpn.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michael H Guo
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, USA.
| | - Lauren A Beslow
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, USA; Division of Neurology, Children's Hospital of Philadelphia, USA.
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Bahri R, Sharma RS, Jain V. Mineralizing angiopathy with basal ganglia stroke after minor head trauma; a clinical profile and follow up study of a large series of paediatric patients from North India. Eur J Paediatr Neurol 2021; 33:61-67. [PMID: 34077857 DOI: 10.1016/j.ejpn.2021.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is paucity of published literature on follow-up outcome of mineralizing angiopathy with basal ganglia stroke related to minor head trauma. This retrospective study aims to bridge this knowledge gap. METHODS Patients (1 months- 15 years), presenting with acute stroke over a 5-year period were recruited. From this cohort, basal ganglia strokes following minor head trauma were analysed in detail and outcome assessed using the Recovery and Recurrence Questionnaire (RRQ). RESULTS A total of 94 patients were eligible, 48 (51%) were basal ganglia stroke following minor head trauma [M: F 2.5:1; mean age 21 ± 8.5 (±SD months]. Further evaluation of this group revealed a median time of 60 min (range 0-96 h) from trauma to stroke onset. Nearly all had acute hemiparesis (45/48). Almost a third of patients (n = 13; 27%) had a transient hemi dystonia on the hemiparetic side after a median of 4 days (range 2-6 days) of symptom onset.Computed tomography (CT) head showed bilateral basal ganglia calcification in all; Most patients (31/48; 64.5%) were anaemic. Magnetic Resonance (MR) angiography, echocardiogram and thrombophilia screen was normal wherever they were performed (6/48).The median follow-up period - 14 months (Range 0-22months). Majority of patients (22/35; 63%) showed complete recovery at 18 months follow up, with maximum recovery occurring between 6 and 12 months. CONCLUSION Minor head trauma leading to basal ganglia stroke in children was the most common cause of paediatric stroke in our patients. In follow-up most patients had recovered fully, though a significant minority did not recover completely.
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Affiliation(s)
- Roshni Bahri
- Departments' of Paediatrics & Paediatric Neurology, Santokba Durlabhji Memorial Hospital, Jaipur, India; Norwich Medical School, University of East Anglia, Norwich, UK
| | - Radhe Shyam Sharma
- Departments' of Paediatrics & Paediatric Neurology, Santokba Durlabhji Memorial Hospital, Jaipur, India
| | - Vivek Jain
- Departments' of Paediatrics & Paediatric Neurology, Santokba Durlabhji Memorial Hospital, Jaipur, India.
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12
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Goraya JS. Intracranial calcifications in childhood. Pediatr Radiol 2021; 51:1539-1540. [PMID: 33433672 DOI: 10.1007/s00247-020-04938-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/21/2020] [Accepted: 12/15/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Jatinder Singh Goraya
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College and Hospital, Ludhiana, Punjab, 141001, India.
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Li T, Ma J, Hong S, Luo Y, Li X, Li T, Jiang L. Childhood ischaemic stroke in the basal ganglia can lead to fine motor and anxiety disorders: a retrospective analysis and follow-up of 109 cases. BMC Neurol 2021; 21:84. [PMID: 33610173 PMCID: PMC7896398 DOI: 10.1186/s12883-021-02112-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/12/2021] [Indexed: 11/28/2022] Open
Abstract
Background Stroke in children easily causes long-term dysfunction. Whether the prognoses of motor and anxiety disorders are related to the affected stroke area has not been reported. Methods One hundred nine cases of children with ischaemic stroke were reviewed and divided into three groups: lenticular nucleus lesions only (lenticular nucleus group), lenticular nucleus and caudate head lesions (caudate head group), and lenticular nucleus and thalamus lesions (thalamus group). Overall prognosis was evaluated by the mRS score. The SCAS-P was used to evaluate anxiety in children aged ≥6 years. Results mRS scores were ≤ 2 points (mean: 0.62), no significant difference among groups. 3/21 (14.2%) patients in the caudate head group changed handedness, which is significantly higher than other groups. Patients with lesions in thalamus group had significantly higher SCAS-P scores. Conclusions The overall prognosis of children with basal ganglia ischaemic stroke is good. However, hand preference changes and anxiety disorders may develop. Patients in the caudate head groups are more likely to suffer from fine motor disorders and changes in handedness. Patients within the thalamus group are more prone to anxiety than patients in the other groups. Anxiety disorders should be noted in children with basal ganglia stroke.
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Affiliation(s)
- Tianyi Li
- Department of Neurology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Jiannan Ma
- Department of Neurology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.
| | - Siqi Hong
- Department of Neurology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Yuanyuan Luo
- Department of Neurology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Xiujuan Li
- Department of Neurology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Tingsong Li
- Department of Neurology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Li Jiang
- Department of Neurology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.
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14
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Gader G, Rkhami M, Zammel I, Badri M. Ischemic stroke following operated head trauma in children: Discussion of a rare clinical case. Int J Surg Case Rep 2021; 79:358-361. [PMID: 33517208 PMCID: PMC7848714 DOI: 10.1016/j.ijscr.2020.12.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 11/29/2022] Open
Abstract
Strokes are rare in paediatric population. Posttraumatic strokes in children may be the result of several linked factors. Postoperative strokes may occur even several days after surgery thus the need for extended follow up. Based on trauma mechanism and consequences, children presenting stroke risk should be early identified.
Introduction Traumatic brain injury (TBI) is the leading cause of morbidity and mortality in children. TBI in children are responsible for a range of clinical symptoms and signs that are comparable to those in adults, but present several differences in both physiopathology and management. Many postoperative complications may occur, ischemic stroke among others, which is generally related to an injury of an intracranial artery. Out of this case, it may be more difficult to find a suitable explanation to this complication. Case presentation We report the case of a child aged years old, who was collided by a car causing a polytrauma with head and chest injury. On body scan, she had a fracture of the sixth left rib, and a frontal cranio-cerebral wound. The patient was operated for debridement of the wound, and tight closure of the injured dura mater. Initial postoperative course was uneventful, but 5 days after first surgery patient presented an acute onset of a right hemiplegia followed by an alteration of her state of consciousness, and a left anisocoria. Follow up CT scan showed a stroke of the whole left carotid territory. The patient was re-operated through a left decompressive craniectomy. Following the second surgery, she showed an improvement of her level of consciousness and a normalization of the size of her pupils, but aphasia and a right hemiplegia persisted. 2 weeks after surgery, the patient had a progressive necrosis of the surgical scar, followed by an exposure of the underlying cerebral cortex. Despite of intensive local care, a plastic surgery to recover the wound and antibiotics, the patient presented a meningitis, followed by a septic shock and death. Clinical discussion and conclusions Ischemic stroke is probably the most harsh and unpredictable complication that may occur after TBI, mainly in children. Only rigorous surgical approach followed by stringent post-operative care may prevent such outcomes.
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Affiliation(s)
- Ghassen Gader
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia.
| | - Mouna Rkhami
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia.
| | - Ihsèn Zammel
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia.
| | - Mohamed Badri
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia.
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15
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Kamate M, Reddy NA, Detroja M. Perinatal Infections: An Important Etiological Risk Factor for Mineralizing Angiopathy. Indian J Pediatr 2021; 88:58-60. [PMID: 32405774 DOI: 10.1007/s12098-020-03332-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/30/2020] [Indexed: 11/29/2022]
Abstract
Though mineralizing angiopathy is increasingly being recognised as a cause of ischemic stroke in young children, it's cause is not clear. As congenital infections and perinatal infections have been proposed to be associated with mineralizing angiopathy, the authors studied the prevalence of perinatal infections in children with mineralizing angiopathy and compared it with focal cerebral arteriopathy and non-stroke patients. Sixteen children with mineralizing angiopathy, 14 children with focal cerebral arteriopathy and 40 non-stroke patients were enrolled. Detailed parental interview was conducted to look for perinatal infection [Premature rupture of membranes (PROM) and neonatal sepsis]. Perinatal infection (PROM in 8 and documented neonatal sepsis in 2) was seen in 8 patients (68.2%) with mineralizing angiopathy and none of the children with focal cerebral arteriopathy. Only 3 (7.5%) of non-stroke patients had history of PROM. This difference was statistically significant. Perinatal infections could be an important etiological risk factor seen in children with mineralizing angiopathy.
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Affiliation(s)
- Mahesh Kamate
- Division of Pediatric Neurology, Department of Pediatrics, KAHER's Jawaharlal Nehru Medical College, Belagavi, Belgaum, Karnataka, India.
| | - Nalla Anuraag Reddy
- Department of Pediatrics, KAHER's Jawaharlal Nehru Medical College, Belagavi, Belgaum, Karnataka, India
| | - Mayank Detroja
- Department of Pediatric Neurology and Child Development, KLES PK Hospital, Belagavi, Belgaum, Karnataka, India
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Nagabushana D, Chandrasekhar S, Venkatesha GA. Mineralizing Angiopathy: An Uncommon Cause of Pediatric Stroke with Good Outcome. ANNALS OF CHILD NEUROLOGY 2021. [DOI: 10.26815/acn.2021.00521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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17
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Cerebrovascular Complications of Pediatric Blunt Trauma. Pediatr Neurol 2020; 108:5-12. [PMID: 32111560 PMCID: PMC7306436 DOI: 10.1016/j.pediatrneurol.2019.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/02/2019] [Accepted: 12/08/2019] [Indexed: 12/13/2022]
Abstract
Ischemic and hemorrhagic stroke can occur in the setting of pediatric trauma, particularly those with head or neck injuries. The risk of stroke appears highest within the first two weeks after trauma. Stroke diagnosis may be challenging due to lack of awareness or concurrent injuries limiting detailed neurological assessment. Other injuries may also complicate stroke management, with competing priorities for blood pressure, ventilator management, or antithrombotic timing. Here we review epidemiology, clinical presentation, and diagnostic approach to blunt arterial injuries including dissection, cerebral sinovenous thrombosis, mineralizing angiopathy, stroke from abusive head trauma, and traumatic hemorrhagic stroke. Owing to the complexities and heterogeneity of concomitant injuries in stroke related to trauma, a single pathway for stroke management is impractical. Therefore providers must understand the goals and possible costs or consequences of stroke management decisions to individualize patient care. We discuss the physiological principles of cerebral perfusion and oxygen delivery, considerations for ventilator strategy when stroke and lung injury are present, and current available evidence of the risks and benefits of anticoagulation to provide a framework for multidisciplinary discussions of cerebrovascular injury management in pediatric patients with trauma.
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Jiang W, Fu J, Chen F, Zhan Q, Wang Y, Wei M, Xiao B. Basal ganglia infarction after mild head trauma in pediatric patients with basal ganglia calcification. Clin Neurol Neurosurg 2020; 192:105706. [DOI: 10.1016/j.clineuro.2020.105706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/19/2019] [Accepted: 01/29/2020] [Indexed: 01/29/2023]
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Wang G, Luan Y, Feng L, Yu J. Current status of infarction in the basal ganglia-internal capsule due to mild head injury in children using PRISMA guidelines. Exp Ther Med 2020; 19:1149-1154. [PMID: 32010282 PMCID: PMC6966180 DOI: 10.3892/etm.2019.8320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 11/08/2019] [Indexed: 12/24/2022] Open
Abstract
Post-traumatic basal ganglia-internal capsule (BGIC) infarction in pediatric patients is a relatively rare consequence of mild head injury (MHI). To the best of the authors' knowledge, at present, no comprehensive review has been published. To review research on BGIC infarction after MHI, a literature search was performed using the PubMed database and relevant search terms. According to recent data, MHI may cause BGIC infarction due to mechanical vasospasm of the perforating vessels in pediatric patients. The anatomical characteristics of the growing brain in infancy, mineralization of the lenticulostriate arteries and viral infection may all play a part in BGIC infarction after MHI, which often occurs within 24 months. Symptoms are not as severe and tend to disappear in the early period. Computed tomography or magnetic resonance imaging often shows BGIC infarction. There are also children with scattered calcification of the basal ganglia. Neural rehabilitation is a commonly accepted treatment. The prognosis of patients with BGIC infarction after MHI consistently improves.
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Affiliation(s)
- Guangming Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yongxin Luan
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Lu Feng
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Cao Q, Yang F, Zhang J, Liang H, Liu X, Wang H. Features of Childhood Arterial Ischemic Stroke in China. Fetal Pediatr Pathol 2019; 38:317-325. [PMID: 30890011 DOI: 10.1080/15513815.2019.1588438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: The aim of this study was to identify the features and risk factors for arterial ischemic stroke (AIS) in children. Methods: We retrospectively analyzed the initial symptoms, clinical manifestations, risk factors, neuroradiological findings, and treatment data of 75 Chinese children aged between 1 month and 14 years (median 5.7 years) who were diagnosed with AIS in our hospital between 2013 and 2018. Results: Among these 75 cases of childhood AIS, 53 patients (70.67%) were male, and the male-to-female ratio was 2.41:1. A total of 55 cases (73.33%) had respiratory tract infection with fever. Seventy cases had lesions in the basal ganglia (46 left, 24 right). All patients were treated conservatively without thrombolytic therapy. Intravenous immunoglobulin treatment was given to children with fever and drowsiness. Conclusion: Infection was an important risk factor for children with AIS in China. Infection and thrombophilia risk factors were more likely to occur in isolation. The stroke lesions commonly occurred in the basal ganglia region.
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Affiliation(s)
- Qingjun Cao
- a Shengjing Hospital of China Medical University , Shenyang , China
| | - Fenghua Yang
- a Shengjing Hospital of China Medical University , Shenyang , China
| | - Junmei Zhang
- a Shengjing Hospital of China Medical University , Shenyang , China
| | - Huo Liang
- a Shengjing Hospital of China Medical University , Shenyang , China
| | - Xueyan Liu
- a Shengjing Hospital of China Medical University , Shenyang , China
| | - Hua Wang
- a Shengjing Hospital of China Medical University , Shenyang , China
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Krishnegowda R, Kashinkunti C, Joshi S. Mineralizing Vasculopathy Causing Motor Delay and Silent Strokes? J Pediatr Neurosci 2019; 13:469-470. [PMID: 30937092 PMCID: PMC6413588 DOI: 10.4103/jpn.jpn_98_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Stroke in children is known to have varied causes and many newer ones continue to be identified. One such recently described entity is mineralizing vasculopathy of lenticulostriate vessels to basal ganglia. Although it is a well-known cause of infantile stroke following trivial head injury, this condition as an etiology of isolated motor delay without a prior history of stroke has not been described. We report a case of an infant with isolated unexplained motor delay who presented with hemidystonia and hemiparesis following a trivial fall. This case is unique because mineralizing vasculopathy as a cause of isolated motor delay prior to presenting as stroke has not been reported before. This case opens up the possibility of isolated motor delay following suspected silent strokes as a clinical presentation of mineralizing vasculopathy. Further studies are needed to determine whether this is a part of a spectrum including more severe clinical picture.
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Affiliation(s)
- Roshani Krishnegowda
- Department of Pediatrics, SDM College of Medical Sciences and Hospital, Dharwad, India
| | - Chetan Kashinkunti
- Department of Neurology, SDM College of Medical Sciences and Hospital, Dharwad, India
| | - Suhas Joshi
- Department of Pediatrics, SDM College of Medical Sciences and Hospital, Dharwad, India
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Baby N, Vinayan KP, Roy AG. Mineralizing Angiopathy of Lenticulostriate Arteries with Infantile Basal Ganglia Infarct Following Minor Head Trauma: A Case Series. Ann Indian Acad Neurol 2019; 22:316-319. [PMID: 31359945 PMCID: PMC6613412 DOI: 10.4103/aian.aian_444_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute arterial ischemic stroke after minor head trauma has been reported in the past, mostly in infants. Most of these affected children had basal ganglia infarct on imaging. Investigations for other etiologies of stroke were noncontributory in most of the cases. Thin-slice computed tomography scan may show mineralizing angiopathy of lenticulostriate arteries. We report a clinical series of four infants who presented with the classical features of this distinct clinico-radiological entity. Clinical characteristics and risk factors at the time of stroke were described in detail. The long-term outcome on standard antiplatelet therapy is reported. None of the children had stroke recurrence during follow-up. The current literature on this clinico-radiological syndrome is reviewed in detail. In the typical cases, extensive etiological workup may not be warranted.
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Affiliation(s)
- Neena Baby
- Department of Neurology, Division of Pediatric Neurology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - K P Vinayan
- Department of Neurology, Division of Pediatric Neurology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Arun Grace Roy
- Department of Neurology, Division of Pediatric Neurology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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A Case of Lenticulostriate Stroke Due to Minor Closed Head Injury in a 2-Year-Old Child: Role of Mineralizing Angiopathy. Pediatr Emerg Care 2018; 34:e233-e235. [PMID: 28816772 DOI: 10.1097/pec.0000000000001229] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Cerebral infarction due to minor head injury is rare. Mineralizing angiopathy is considered a predisposing factor for lenticulostriate stroke after minor closed head injury. This entity is characterized by infarction of the basal ganglia and most often occurs in young children, from infancy to 2 years of age. Symptoms usually occur immediately after the injury. METHODS AND RESULTS We present the case of a previously healthy 2-year-old female child presenting with right facial hemiparesis and aphasia, along with right arm and leg weakness that occurred immediately after a fall from the couch onto a carpeted floor. A brain computed tomography scan revealed small and linear calcifications of the basal ganglia and subcortical frontoparietal area, in the absence of signs of intracranial hemorrhage. Brain magnetic resonance imaging with stroke protocol revealed restriction of water diffusion in the left basal ganglia on diffusion-weighted imaging sequences as well as apparent diffusion coefficient sequences, suggesting an acute infarct of the left basal ganglia within the distribution of the lenticulostriate vessels. The patient was treated with aspirin and conservative management and had gradual improvement over the next few days, with full recovery of the aphasia, facial nerve function, and arm and leg mobility, within 2 months. CONCLUSIONS Some infants can present with the onset of stroke-like symptoms after minor head injuries. Presence of linear calcifications of the basal ganglia noticed on brain computed tomography in many of these patients suggests that mineralizing angiopathy may be a predisposing factor for lenticulostriate stroke after minor closed head injury in infants. Brain magnetic resonance imaging to further delineate possible cerebral infarction is indicated.
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25
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Kasinathan A, Senthilkumaran R, Chandramohan A, Saravanan V, Soundararajan P. Infantile stroke: consider minor head trauma. Childs Nerv Syst 2018; 34:2141-2142. [PMID: 30091115 DOI: 10.1007/s00381-018-3945-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Ananthanarayanan Kasinathan
- Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, 607402, India.
| | - Ravikumar Senthilkumaran
- Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, 607402, India
| | - Anandhi Chandramohan
- Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, 607402, India
| | - Vinoth Saravanan
- Department of Radiodiagnosis, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, 607402, India
| | - P Soundararajan
- Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, 607402, India
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26
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Goraya JS, Berry S. Reply to Letter on "Stroke After Minor Head Trauma in Infants and Young Children With Basal Ganglia Calcification: A Lenticulostriate Vasculopathy?". J Child Neurol 2018; 33:556-557. [PMID: 29714093 DOI: 10.1177/0883073818772694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jatinder Singh Goraya
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Shivankshi Berry
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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27
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Chang CL, Chiu NC. Letter to the Editor Regarding "Stroke After Minor Head Trauma in Infants and Young Children With Basal Ganglia Calcification: A Lenticulostriate Vasculopathy?". J Child Neurol 2018; 33:554-555. [PMID: 29714087 DOI: 10.1177/0883073818772646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chaw-Liang Chang
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.,Department of Pediatrics, Cathay General Hospital, Hsinchu, Taiwan
| | - Nan-Chang Chiu
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan.,Mackay Medical College, New Taipei City, Taiwan
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Cecchini C, Iqbal S, Murnick J. Case 4: Stroke after Minor Trauma in an Otherwise Healthy 18-month-old Boy. Pediatr Rev 2018; 39:313. [PMID: 29858296 DOI: 10.1542/pir.2017-0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Sabah Iqbal
- Pediatric Emergency Medicine, Children's National Health System, Washington, DC
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Goraya JS, Berry S, Saggar K, Ahluwalia A. Stroke After Minor Head Trauma in Infants and Young Children With Basal Ganglia Calcification: A Lenticulostriate Vasculopathy? J Child Neurol 2018; 33:146-152. [PMID: 29334856 DOI: 10.1177/0883073817750501] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors retrospectively reviewed charts of the children with basal ganglia stroke who either had preceding minor head injury or showed basal ganglia calcification on computed tomography (CT) scan. Twenty children, 14 boys and 6 girls were identified. Eighteen were aged between 7 months to 17 months. Presentation was with hemiparesis in 17 and seizures in 3. Preceding minor head trauma was noted in 18. Family history was positive in 1 case. Bilateral basal ganglia calcification on CT scan was noted in 18. Brain magnetic resonance imaging done in 18 infants showed acute or chronic infarcts in basal ganglia. Results of other laboratory and radiological investigations were normal. Four infants were lost to follow-up, 9 achieved complete or nearly completely recovery, and 7 had persistent neurological deficits. Basal ganglia calcification likely represents mineralized lenticulostriate arteries, a marker of lenticulostriate vasculopathy. Abnormal lenticulostriate vessels are vulnerable to injury and thrombosis after minor head trauma resulting in stroke.
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Affiliation(s)
- Jatinder Singh Goraya
- 1 Department of Pediatrics, Division of Pediatric Neurology, Ludhiana, Punjab, India
| | - Shivankshi Berry
- 1 Department of Pediatrics, Division of Pediatric Neurology, Ludhiana, Punjab, India
| | - Kavita Saggar
- 2 Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Archana Ahluwalia
- 2 Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Gowda VK, Manjeri V, Srinivasan VM, Sajjan SV, Benakappa A. Mineralizing Angiopathy with Basal Ganglia Stroke after Minor Trauma: Case Series Including Two Familial Cases. J Pediatr Neurosci 2018; 13:448-454. [PMID: 30937087 PMCID: PMC6413602 DOI: 10.4103/jpn.jpn_89_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Basal ganglia stroke following trauma has been known to occur and described in previous case studies. But exact etiology is unknown. Aim: To study the clinical characteristics, imaging features, and neurodevelopmental outcomes of children presented with basal ganglia stroke associated with mineralization in the lenticulostriate arteries in our center from January 2013 to June 2016. Subjects and Methods: Children with subcortical stroke during the study period were identified retrospectively, and those presented with basal ganglia stroke with mineralization of lenticulostriate vessels were analyzed for clinical profile, imaging features, and outcomes. Statistical analysis was carried out using the Statistical Package for the Social Sciences (SPSS) software, version 17 (IBM, New York). Results: Of 38 children with basal ganglia stroke (20 boys, 18 girls, and mean age at presentation 14.026±5.8470 months), 27 had history of trauma preceding the stroke. Thirty-seven children presented with hemiparesis and one presented with hemidystonia. The mean follow-up time was 8 months, three children developed recurrence during that period. Five children with recurrence of stroke, initial episodes were not evaluated as they presented to us for the first time. A total of 17 of 30 infants who did not have stroke recurrence were normal on follow-up, whereas 9 infants showed persistent mild hemiparesis, 2 had motor delay, and 2 others had mild residual distal weakness. No identifiable causes were observed for vascular calcification. Two familial cases were also noted. Conclusion: Most common cause for acute basal ganglia stroke in toddlers was mineralizing angiopathy of lenticulostriate vessels. It was preceded by minor trauma in most cases.
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Affiliation(s)
- Vykuntaraju K Gowda
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Vidya Manjeri
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Varunvenkat M Srinivasan
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Sushma V Sajjan
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Asha Benakappa
- Department of Pediatrics, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
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Kamate M, Malhotra M, Gangamma DH, Hattiholi V. Acute encephalopathy: A novel presentation of mineralizing microangiopathy of childhood. Ann Indian Acad Neurol 2016; 19:528-530. [PMID: 27994370 PMCID: PMC5144482 DOI: 10.4103/0972-2327.194465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mahesh Kamate
- Department of Pediatric Neurology, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Mukul Malhotra
- Department of Pediatrics, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - D H Gangamma
- Department of Pediatrics, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Virupaxi Hattiholi
- Department of Radiology, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
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Jauhari P, Sankhyan N, Khandelwal N, Singhi P. Childhood Basal Ganglia Stroke and its Association with Trivial Head Trauma. J Child Neurol 2016; 31:738-42. [PMID: 26668054 DOI: 10.1177/0883073815620674] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 10/05/2015] [Indexed: 11/15/2022]
Abstract
This study explored the clinical profile, risk factors, neuroimaging and outcome of childhood basal ganglia stroke. Children (6 months-12 years) with basal ganglia stroke registered between 2007-2011 were retrospectively enrolled, while newly diagnosed cases over the 2-year study period were enrolled prospectively. Children with recent trivial head trauma were compared with those without it. Of the 35 children enrolled, trivial head trauma was seen in 74%. The non-trivial head trauma group (n = 9) comprised unidentified etiology (4), Moyamoya syndrome (2), varicella infection (1), homocysteinemia (1), and probable mitochondrial cytopathy (1). Median duration to complete recovery was significantly less in the trivial head trauma group (median = 12, range = 1-72 weeks vs median = 38, range = 20-48 weeks,P= .001). Moreover, these children had increased chances of complete recovery (85% [22/26] vs 44.5% [4/9],P= .029). Basal ganglia stroke can follow trivial head trauma and may have a more favorable outcome.
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Affiliation(s)
- Prashant Jauhari
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pratibha Singhi
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Yang ST, Lee WT, Hung KL, Chang CL. Infantile basal ganglia stroke after mild head trauma. Neurology 2015; 84:2381-2. [PMID: 26054894 DOI: 10.1212/wnl.0000000000001669] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Su-Tin Yang
- From the Department of Pediatrics (S.-T.Y., C.-L.C.) and Center for Medical Teaching and Research (C.-L.C.), Cathay General Hospital, Hsinchu; Department of Pediatrics (W.-T.L.), National Taiwan University Hospital, Taipei; and the Department of Pediatrics (K.-L.H.), Cathay General Hospital, Taipei, and School of Medicine, Fu-Jen Catholic University (K.-L.H.), New Taipei City, Taiwan
| | - Wang-Tso Lee
- From the Department of Pediatrics (S.-T.Y., C.-L.C.) and Center for Medical Teaching and Research (C.-L.C.), Cathay General Hospital, Hsinchu; Department of Pediatrics (W.-T.L.), National Taiwan University Hospital, Taipei; and the Department of Pediatrics (K.-L.H.), Cathay General Hospital, Taipei, and School of Medicine, Fu-Jen Catholic University (K.-L.H.), New Taipei City, Taiwan
| | - Kun-Long Hung
- From the Department of Pediatrics (S.-T.Y., C.-L.C.) and Center for Medical Teaching and Research (C.-L.C.), Cathay General Hospital, Hsinchu; Department of Pediatrics (W.-T.L.), National Taiwan University Hospital, Taipei; and the Department of Pediatrics (K.-L.H.), Cathay General Hospital, Taipei, and School of Medicine, Fu-Jen Catholic University (K.-L.H.), New Taipei City, Taiwan
| | - Chaw-Liang Chang
- From the Department of Pediatrics (S.-T.Y., C.-L.C.) and Center for Medical Teaching and Research (C.-L.C.), Cathay General Hospital, Hsinchu; Department of Pediatrics (W.-T.L.), National Taiwan University Hospital, Taipei; and the Department of Pediatrics (K.-L.H.), Cathay General Hospital, Taipei, and School of Medicine, Fu-Jen Catholic University (K.-L.H.), New Taipei City, Taiwan.
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34
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Jain P, Kishore P, Bhasin JS, Arya SC. Mineralizing angiopathy with basal ganglia stroke in an infant. Ann Indian Acad Neurol 2015; 18:233-4. [PMID: 26019426 PMCID: PMC4445204 DOI: 10.4103/0972-2327.150619] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/14/2014] [Accepted: 10/26/2014] [Indexed: 01/31/2023] Open
Abstract
Basal ganglia stroke is known following trivial head trauma. Recently a distinct clinic-radiological entity termed ‘mineralizing angiopathy’ was described. We report an infant who developed basal ganglia stroke following trivial fall. His clinic-radiological features are described.
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Affiliation(s)
- Puneet Jain
- Department of Pediatrics, BL Kapur Super Speciality Hospital, New Delhi, India ; Department of Division of Pediatric Neurology, BL Kapur Super Speciality Hospital, New Delhi, India
| | - Praveen Kishore
- Department of Pediatrics, BL Kapur Super Speciality Hospital, New Delhi, India
| | - Jasjit Singh Bhasin
- Department of Pediatrics, BL Kapur Super Speciality Hospital, New Delhi, India
| | - Subhash Chand Arya
- Department of Pediatrics, BL Kapur Super Speciality Hospital, New Delhi, India
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Abstract
Stroke is as common as brain tumor in children. The etiology of childhood arterial ischemic stroke (AIS) appears to be multifactorial, resulting from the interaction between genetic predisposition and environmental triggers. The risk factors for AIS in children are markedly different from the atherosclerotic risk factors in adults. Trauma and infections have been identified as associations in previous studies and are exposures of particular interest because of their increased prevalence in the children. The aim of this review article is to provide an overview of the research studies that have addressed the role of infections and trauma in pediatric AIS.
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Affiliation(s)
- Elena Moraitis
- Rheumatology/Infectious Diseases and Immunity Unit UCL Institute of Child Health and Rheumatology Department, Great Ormond Street Hospital for Children, London, UK,
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Kim TH, Lee KS, Park HR, Shim JJ, Yoon SM, Doh JW. A Design for Evaluation of the Trauma Apportionment in Cerebral Infarction after Trauma. J Korean Neurosurg Soc 2015; 57:19-22. [PMID: 25674339 PMCID: PMC4323500 DOI: 10.3340/jkns.2015.57.1.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/29/2014] [Accepted: 05/31/2014] [Indexed: 11/27/2022] Open
Abstract
Objective Posttraumatic cerebral infarction (CI) is a well-known complication of traumatic brain injury (TBI). However, the causation and apportionment of trauma in patients with CI after TBI is not easy. There is a scoring method, so-called trauma apportionment score (TAS) for CI, consisted with the age, the interval, and the severity of the TBI. We evaluated the reliability of this score. Methods We selected two typical cases of traumatic CI. We also selected consecutive 50 patients due to spontaneous CI. We calculated TAS in both patients with traumatic and spontaneous CI. To enhance the reliability, we revised TAS (rTAS) adding three more items, such as systemic illness, bad health habits, and doctor's opinion. We also calculated rTAS in the same patients. Results Even in 50 patients with spontaneous CI, the TAS was 4 in 44 patients, and 5 in 6 patients. TAS could not assess the apportionment of trauma efficiently. We recalculated the rTAS in the same patients. The rTAS was not more than 11 in more than 70% of the spontaneous CI. Compared to TAS, rTAS definitely enhanced the discriminating ability. However, there were still significant overlapping areas. Conclusion TAS alone is insufficient to differentiate the cause or apportionment of trauma in some obscure cases of CI. Although the rTAS may enhance the reliability, it also should be used with cautions.
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Affiliation(s)
- Tae-Hoon Kim
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Kyeong-Seok Lee
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hae-Ran Park
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jae-Joon Shim
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Seok-Mann Yoon
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jae-Won Doh
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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Komarova IB, Zykov VP, Shuleshko OV, Mamedova LS, Netesova EV, Voronenko OA. Arterial ischemic stroke in children with mild head trauma. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:28-34. [DOI: 10.17116/jnevro20151155228-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kim BJ, Choi JI, Ha SK, Lim DJ, Kim SD. Hidden dense middle cerebral artery sign in a 4-year-old boy with traumatic subarachnoid hemorrhage. J Child Neurol 2014; 29:NP189-92. [PMID: 24282184 DOI: 10.1177/0883073813510357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 4-year-old boy was admitted with acute onset of hemiplegia of the right side that was secondary to a traffic accident. Initial computed tomography revealed a traumatic subarachnoid hemorrhage, and follow-up computed tomography showed a more localized hematoma of the left sylvian cistern. After a few days of conservative treatment, magnetic resonance imaging (MRI) revealed a cerebral infarction of the left lenticulostriate territory, even though magnetic resonance angiography showed preserved middle cerebral artery flow. Thus, we realized that the hematoma of the sylvian cistern was the so-called dense middle cerebral artery sign. This case of posttraumatic infarction suggested the importance of meticulous investigations and clinical correlations of imaging studies in pediatric patients with head injuries.
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Affiliation(s)
- Bum-Joon Kim
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan, Korea
| | - Jong-Il Choi
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan, Korea
| | - Sung-Kon Ha
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan, Korea
| | - Dong-Jun Lim
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan, Korea
| | - Sang-Dae Kim
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan, Korea
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Numis AL, Fox CK. Arterial ischemic stroke in children: risk factors and etiologies. Curr Neurol Neurosci Rep 2014; 14:422. [PMID: 24384876 DOI: 10.1007/s11910-013-0422-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Stroke is increasingly recognized as a significant cause of morbidity and mortality in children, and as a financial burden for families and society. Recent studies have identified and confirmed presumptive risk factors, and have identified novel associations with childhood arterial ischemic stroke. A better understanding of risk factors for stroke in children, which differ from the atherosclerotic risk factors in adults, is the first step needed to improve strategies for stroke prevention and intervention, and ultimately minimize the physical, mental, and financial burden of arterial ischemic stroke. Here, we discuss recent advances in research for selected childhood stroke risk factors, highlighting the progress made in our understanding of etiologic mechanisms and pathophysiology, and address the future directions for acute and long-term treatment strategies for pediatric stroke.
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Affiliation(s)
- Adam L Numis
- Division of Child Neurology, University of California, San Francisco, 675 Nelson Rising Lane, 402 B, San Francisco, CA, 94143, USA
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Lingappa L, Varma RD, Siddaiahgari S, Konanki R. Mineralizing angiopathy with infantile basal ganglia stroke after minor trauma. Dev Med Child Neurol 2014; 56:78-84. [PMID: 24102209 DOI: 10.1111/dmcn.12275] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 11/26/2022]
Abstract
AIMS The objective of this study was to describe a cohort of infants with basal ganglia stroke associated with mineralization in the lenticulostriate arteries and their clinical outcomes. METHOD Subcortical strokes occurring in infants during the study period were categorized as arterial ischaemic, venous, or haemorrhagic. A cohort of infants with basal ganglia infarcts and associated mineralization of lenticulostriate arteries were identified. This group was analysed for possible aetiological factors, clinical course, and recurrence rate of the stroke. RESULTS Of 23 infants with basal ganglia arterial ischaemic stroke, 22 (16 males, six females; mean age 11mo [±SD 4.8mo]) were found to have lenticulostriate artery mineralization. Twenty infants presented with hemiparesis and two presented with recurrent episodes of hemidystonia. Eighteen infants had a history of minor trauma before onset of stroke. No other predisposing factors were identified in this cohort. There were no demonstrable causes for vascular and soft tissue calcification. The mean follow-up was 11 months, during which five infants experienced stroke recurrence. Of the 17 infants who did not experience a recurrent stroke, eight exhibited complete neurological recovery, and nine had mild residual hemiparesis. INTERPRETATION Acute basal ganglia stroke after minor trauma associated with mineralization of lenticulostriate arteries in infants is a distinct clinicoradiological entity. Investigations for prothrombotic states and vasculopathies are normal. Although neurological outcomes in most children are good, trauma is a risk factor for recurrence of stroke.
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Affiliation(s)
- Lokesh Lingappa
- Department of Pediatric Neurology, Rainbow Hospital for Women and Children, Hyderabad, India
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Affiliation(s)
- Gabrielle Deveber
- The Hospital for Sick Children - Division of Neurology, Toronto, ON, Canada
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