1
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Lu P, Cui L, Zhang X. Stroke risk after varicella-zoster virus infection: a systematic review and meta-analysis. J Neurovirol 2023; 29:449-459. [PMID: 37219811 DOI: 10.1007/s13365-023-01144-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/11/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023]
Abstract
Varicella-zoster virus (VZV) infection may cause vascular inflammatory changes leading to an increased risk of stroke. Previous studies have focused on the risk of stroke and less on changes in stroke risk and prognosis. We aimed to explore the changing patterns of stroke risk and stroke prognosis after VZV infection. This study is a systematic review and meta-analysis. We searched PubMed, Embase, and the Cochrane Library for studies on stroke after VZV infection between January 1, 2000, and October 5, 2022. Relative risks were combined for the same study subgroups using a fixed-effects model and pooled across studies using a random-effects model. 27 studies met the requirements, including 17 herpes zoster (HZ) studies and ten chickenpox studies. There was an increased risk of stroke after HZ, and this risk decreased over time: relative risk 1.80 (95% CI 1.42-2.29) within 14 days, 1.61 (95% CI 1.43-1.81) within 30 days, 1.45 (95% CI 1.33-1.58) within 90 days, 1.32 (95% CI 1.25-1.39) within 180 days, 1.27 (95% CI 1.15-1.40) at one year and 1.19 (95% CI 0.90-1.59) after one year, with the same trend in the stroke subtype. The risk of stroke after herpes zoster ophthalmicus was higher, with a maximum relative risk of 2.26 (95% CI 1.35-3.78). The risk of stroke after HZ was higher in patients aged around 40 years: relative risk 2.53 (95% CI 1.59-4.02), and similar in men and women. Also, after pooling studies of post-chickenpox stroke, we found that the middle cerebral artery and its branches were most frequently involved (78.2%), with a better prognosis in most patients (83.1%) and less frequent vascular persistence progression (8.9%). In conclusion, the risk of stroke increases after VZV infection, decreasing over time. Post-infection vascular inflammatory changes often occur in the middle cerebral artery and its branches, with a better prognosis in most patients and less frequent persistent progression.
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Affiliation(s)
- Ping Lu
- Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring Road West, Beijing, China
| | - Lingyun Cui
- Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring Road West, Beijing, China
| | - Xinghu Zhang
- Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring Road West, Beijing, China.
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2
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D'Antini D, Perrotta F. Post-traumatic ischaemic stroke in a teenager after head trauma: A case report. Trauma Case Rep 2023; 45:100835. [PMID: 37206626 PMCID: PMC10189456 DOI: 10.1016/j.tcr.2023.100835] [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] [Accepted: 05/03/2023] [Indexed: 05/21/2023] Open
Abstract
Background Lacunar strokes in the pediatric population are very uncommon, as well as trauma-induced strokes. It is extremely rare for a head trauma induced ischaemic stroke to occur in children and young adults. Case report We describe a case of a 13-year-old boy who reported acute ischaemic lesions, and in particular a right basal ganglia ischaemic stroke after falling from a height of 10 m, presumably secondary to the stretching-induced occlusion of the recurrent artery of Heubner, with a favorable outcome. Conclusion Ischaemic strokes can rarely be subsequent to head trauma in young adults, in relationship with the degree of maturity of the perforating vessels. Although very rare, it is important to avoid the lack of recognition of this condition, thus awareness is necessary.
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Affiliation(s)
- Davide D'Antini
- Corresponding author at: Department of Anesthesia and Intensive Care, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, viale Cappuccini, S. Giovanni Rotondo 71043, Foggia, Italy.
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3
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Astrocytosis, Inflammation, Axonal Damage and Myelin Impairment in the Internal Capsule following Striatal Ischemic Injury. Cells 2023; 12:cells12030457. [PMID: 36766798 PMCID: PMC9913724 DOI: 10.3390/cells12030457] [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] [Received: 09/14/2022] [Revised: 12/29/2022] [Accepted: 01/20/2023] [Indexed: 02/04/2023] Open
Abstract
Secondary degeneration is defined as a set of destructive events that damage cells and structures that were initially spared or only peripherally affected by the primary insult, constituting a key factor for functional impairment after traumatic brain injury or stroke. In the present study, we evaluated the patterns of astrocytosis, inflammatory response, axonal damage and oligodendrocytes/myelin impairment in the internal capsule following a focal injection of endothelin-1 (ET-1) into the dorsal striatum. Animals were perfused at 1, 3 and 7 post-lesion days (PLD), and tissue was processed to immunohistochemistry for neutrophils (MBS1), macrophages/microglia (ED1), astrocytes (GFAP), axonal lesion (βAPP), oligodendrocytes (Tau) and myelin (MBP). A significant number of neutrophils was observed at 1PLD, followed by intense recruitment/activation of macrophages/microglia at 3PLD and astrocytic reaction with a peak at 7PLD. Oligodendrocyte damage was pronounced at 3PLD, remaining at 7PLD. Progressive myelin impairment was observed, with reduction of immunoreactivity at 7PLD. Axonal lesion was also identified, mainly at 7PLD. Our results indicate that acute inflammatory response elicited by the ischemic insult in the striatum can be associated with the axonal impairment and damage of both oligodendrocytes and myelin sheath identified in the internal capsule, which may be related to loss of tissue functionality observed in secondary degeneration.
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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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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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6
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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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7
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Bhardwaj H, Swami M, Singh A, Kaushik JS. Mineralizing angiopathy presenting with recurrence of basal ganglia stroke following minor head trauma. J Postgrad Med 2019; 65:116-118. [PMID: 30924444 PMCID: PMC6515775 DOI: 10.4103/jpgm.jpgm_474_18] [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: 11/29/2022] Open
Abstract
Basal ganglia stroke secondary to mineralizing angiopathy of lenticulostriate arteries is a well-recognized clinical entity following minor head trauma in children. Recurrences are uncommon, and the majority of these recurrences occur within a few months of initial insult. We report a 2-year-old boy who developed recurrence of basal ganglia stroke after a latency of 18 months from the time of first unrecognized insult at 6 months of age. The case brings forth the need to recognize the condition of basal ganglia stroke secondary to mineralizing angiopathy considering the risk of recurrence to occur as far as 18 months after the first stroke.
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Affiliation(s)
- H Bhardwaj
- Department of Paediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - M Swami
- Department of Paediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - A Singh
- Department of Paediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - J S Kaushik
- Department of Paediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
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8
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McCrea N, Fullerton HJ, Ganesan V. Genetic and Environmental Associations With Pediatric Cerebral Arteriopathy. Stroke 2019; 50:257-265. [DOI: 10.1161/strokeaha.118.020479] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Nadine McCrea
- From the Department of Neurology, Great Ormond Street Hospital for Children NHS Foundation Trust, London (N.M.)
| | | | - Vijeya Ganesan
- Clinical Neurosciences, UCL Great Ormond Street Institute of Child Health, London (V.G.)
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9
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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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10
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Liu SW, Huang LC, Chung WF, Chang HK, Wu JC, Chen LF, Chen YC, Huang WC, Cheng H, Lo SS. Increased Risk of Stroke in Patients of Concussion: A Nationwide Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030230. [PMID: 28245607 PMCID: PMC5369066 DOI: 10.3390/ijerph14030230] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/14/2017] [Accepted: 02/17/2017] [Indexed: 11/30/2022]
Abstract
Long-term morbidities can develop after traumatic brain injury (TBI). Some studies have suggested that the risk of stroke is higher after TBI, but the association between concussion and stroke remains unclear. Using a national cohort, the authors analyzed the incidence of both hemorrhagic and ischemic strokes in patients with previous concussion. A representative cohort of approximately one million people was followed up for four years. Patients with new-onset concussion were identified (n = 13,652) as the concussion group. Subsequently, the incidence rates of later stroke events in the concussion group were compared to a sex-, age- and propensity score–matched comparison group (n = 13,652). The overall incidence rate of stroke in the concussion group was higher than that of the comparison group (9.63 versus 6.52 per 1000 person-years, p < 0.001). Significantly higher stroke risk was observed in the concussion group than in the comparison group (crude hazard ratio 1.48, p < 0.001; adjusted HR 1.65, p < 0.001). In the concussion group, the cumulative incidence rates of both ischemic stroke and hemorrhagic stroke were higher than those of the comparison group (8.9% vs. 5.8% and 2.7% vs. 1.6%, respectively, both p < 0.001). Concussion is an independent risk factor for both ischemic and hemorrhagic strokes. Prevention and monitoring strategies of stroke are therefore suggested for patients who have experienced concussion.
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Affiliation(s)
- Shih-Wei Liu
- Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan.
| | - Liang-Chung Huang
- Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan.
| | - Wu-Fu Chung
- Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan.
| | - Hsuan-Kan Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan.
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Li-Fu Chen
- Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Yu-Chun Chen
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
- Department of Medical Research and Education, National Yang-Ming University Hospital, I-Lan 260, Taiwan.
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei 112, Taiwan.
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Henrich Cheng
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Institute of Pharmacology, National Yang-Ming University, Taipei 112, Taiwan.
| | - Su-Shun Lo
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
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11
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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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12
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Yilmaz A, Kizilay Z, Ozkul A, Çirak B. Pure Motor Stroke Secondary to Cerebral Infarction of Recurrent Artery of Heubner after Mild Head Trauma: A Case Report. Open Access Maced J Med Sci 2016; 4:139-41. [PMID: 27275348 PMCID: PMC4884235 DOI: 10.3889/oamjms.2016.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/18/2015] [Accepted: 12/19/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The recurrent Heubner's artery is the distal part of the medial striate artery. Occlusion of the recurrent artery of Heubner, classically contralateral hemiparesis with fasciobrachiocrural predominance, is attributed to the occlusion of the recurrent artery of Heubner and is widely known as a stroke syndrome in adults. However, isolated occlusion of the deep perforating arteries following mild head trauma also occurs extremely rarely in childhood. CASE REPORT Here we report the case of an 11-year-old boy with pure motor stroke. The brain MRI showed an acute ischemia in the recurrent artery of Heubner supply area following mild head trauma. His fasciobrachial hemiparesis and dysarthria were thought to be secondary to the stretching of deep perforating arteries leading to occlusion of the recurrent artery of Heubner. CONCLUSION Post-traumatic pure motor ischemic stroke can be secondary to stretching of the deep perforating arteries especially in childhood.
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Affiliation(s)
- Ali Yilmaz
- Adnan Menderes University, Faculty of Medicine, Neurosurgery Department, Aydin, Turkey
| | - Zahir Kizilay
- Adnan Menderes University, Faculty of Medicine, Neurosurgery Department, Aydin, Turkey
| | - Ayca Ozkul
- Adnan Menders University, Faculty of Medicine, Department of Neurology, Aydin, Turkey
| | - Bayram Çirak
- Pamukkale University, Faculty of Medicine, Department of Neurosurgery, Denizli, Turkey
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13
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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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14
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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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15
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Zwank MD, Dummer BW, Danielson LT, Haake BC. Lacunar stroke in a teenager after minor head trauma: case report and literature review. J Child Neurol 2014; 29:NP65-8. [PMID: 24072020 DOI: 10.1177/0883073813500850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ischemic strokes in children and young adults are fortunately rare. Contrasted with adult ischemic strokes, pediatric stroke etiologies vary greatly and are often unknown. Childhood lacunar strokes and trauma-induced strokes represent particularly uncommon subsets and have been reported infrequently in the literature. It is unique to find a combination of the 2-a lacunar stroke induced by trauma. Underreporting of these trauma-induced ischemic strokes could be responsible for perpetuating the lack of recognition. Here we present a lacunar stroke in a young woman associated with a water sport accident and explore relevant literature encircling deep brain ischemia coinciding with trauma.
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16
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Chabrier S, Darteyre S, Mazzola L, Stéphan JL. [Childhood cerebral vasculitis]. Arch Pediatr 2014; 21:884-93. [PMID: 24998326 DOI: 10.1016/j.arcped.2014.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 02/27/2014] [Accepted: 05/12/2014] [Indexed: 12/29/2022]
Abstract
Central nervous system vasculitides are defined as the invasion of the vascular wall by blood-borne inflammatory cells. In childhood, they may be classified according to their trigger event (infectious vs. non-infectious), their temporal course (time-limited vs. chronic), and the size of the affected vessel. Diseases apparently confined to the central nervous system are also distinguished from secondary forms, associated with infection or rheumatic or systemic inflammatory disorders. Large-vessel vasculitis, the most frequent form, causes stroke and presents with acute focal deficits. MR, or more seldom contrast angiography is required for the positive diagnosis, while the child's medical history conveys the etiological diagnosis. The clinical manifestations of small-vessel vasculitis include headaches, seizures, focal deficits, cognitive decline, and behavior changes that can occur insidiously over a few weeks or a few months. The diagnosis is based on the associated clinical and biological symptoms in secondary forms and on cerebromeningeal biopsy in primary forms. Secondary forms of vasculitides are treated according to the etiology. The injury of large basal arteries is often observed after infection, especially varicella, and is also called transient focal cerebral arteriopathy (TCA) or post-varicella arteriopathy (PVA). This focal, monophasic, and time-limited entity is highly specific of childhood. There are no arguments in the current literature supporting the hypothesis that an aggressive immunomodulatory treatment would be more effective, in terms of recurrence rate or functional outcome, than aspirin alone. In contrast, the diffuse, prolonged, and aggressive course of the rare primary vasculitis of the central nervous system requires a prolonged immunosuppressive treatment. The management of associated symptoms, treatment-related adverse effects, and sequelae is based on a multidisciplinary approach.
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Affiliation(s)
- S Chabrier
- Pôle Couple-Mère-Enfant, hôpital Bellevue, CHU de Saint-Etienne, 42055 Saint-Etienne cedex 2, France.
| | - S Darteyre
- Pôle Couple-Mère-Enfant, hôpital Bellevue, CHU de Saint-Etienne, 42055 Saint-Etienne cedex 2, France
| | - L Mazzola
- Pôle Couple-Mère-Enfant, hôpital Bellevue, CHU de Saint-Etienne, 42055 Saint-Etienne cedex 2, France
| | - J-L Stéphan
- Pôle Couple-Mère-Enfant, hôpital Bellevue, CHU de Saint-Etienne, 42055 Saint-Etienne cedex 2, France
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Mallick AA, O’Callaghan FJK. Risk factors and treatment outcomes of childhood stroke. Expert Rev Neurother 2014; 10:1331-46. [DOI: 10.1586/ern.10.106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Cerebral infarction after mild head trauma in children. Indian Pediatr 2013; 50:875-8. [DOI: 10.1007/s13312-013-0231-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 03/12/2013] [Indexed: 10/26/2022]
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Yang FH, Wang H, Zhang JM, Liang HY. Clinical features and risk factors of cerebral infarction after mild head trauma under 18 months of age. Pediatr Neurol 2013; 48:220-6. [PMID: 23419473 DOI: 10.1016/j.pediatrneurol.2012.12.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 12/17/2012] [Indexed: 01/23/2023]
Abstract
Mild head trauma can cause cerebral infarction in children younger than 18 months of age, yet the pathogenesis, clinical characteristics, and risk factors are not fully understood. Data of 16 cases between August 2008 and September 2011, including clinical manifestations and imaging and laboratory findings were collected and analyzed. All patients had the history of mild head trauma. The median age of the cohort was 13.5 months (range 6 months to 18 months). All children developed neurologic symptoms and signs within 72 hours after trauma, 62.5% (10/16) within 30 minutes. The first symptoms included hemiparesis (9/16), facial paresis (4/16), and convulsion (6/16). Overall, 93.75% (15/16) of the lesions were in the basal ganglia region. Two risk factors were identified, basal ganglia calcification in 10 and cytomegalovirus infection in eight. After conservative therapy, the neurologic deficits recovered to some extent. Cerebral infarction after mild head trauma in children younger than 18 months of age may take place, especially under the circumstances of basal ganglia calcification or cytomegalovirus infection.
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Affiliation(s)
- Feng-Hua Yang
- Department of Pediatric Neurology, Shengjing Hospital of China Medical University, Shenyang 110004, China.
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Accidental chopstick injury resulting in internal capsule lesion and intracerebral hemorrhage. Am J Phys Med Rehabil 2011; 90:959. [PMID: 21885946 DOI: 10.1097/phm.0b013e318228be0c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Landi A, Marotta N, Mancarella C, Marruzzo D, Salvati M, Delfini R. Basal ganglia stroke due to mild head trauma in pediatric age - clinical and therapeutic management: a case report and 10 year literature review. Ital J Pediatr 2011; 37:2. [PMID: 21210991 PMCID: PMC3024947 DOI: 10.1186/1824-7288-37-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 01/06/2011] [Indexed: 11/10/2022] Open
Abstract
Ischemia of the basal ganglia as an immediate consequence of minor head injury in children is rare (< 2% of all ischemic stroke in childhood) and is due to vasospasm of the lenticulostriate arteries. The clinical history of these lesions is particularly favourable because they are usually small, and also because the facial-brachial-crural hemiparesis typical of this pathology usually regresses after a period ranging from several weeks to several months, despite the persistence of an ischemic area on MRI. This is due to the well known neuronal plasticity of the CNS, in particular, of the primary motor cortex. The most effective therapeutic approach appears to be the conservative one, although the best treatment regimen is still not well defined.Young patients should be closely monitored and treated conservatively with osmotic diuretics to reduce perilesional edema. At the same time, however, it is very important to exclude, by means of instrumental and laboratory studies, conditions that could favour the onset of ischemia, including emboligen heart disease, thrombophilia and acute traumatic arterial dissections. Generally speaking, the prognosis in these cases is good. The authors describe their experience treating a 10-month old baby girl, with a left lenticular nucleus ischemia and report a literature review.
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Affiliation(s)
- Alessandro Landi
- Department of Neurosurgical Sciences, University of Rome "Sapienza", Italy.
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Buerki S, Roellin K, Remonda L, Mercati DG, Jeannet PY, Keller E, Luetschg J, Menache C, Ramelli GP, Schmitt-Mechelke T, Weissert M, Boltshauser E, Steinlin M. Neuroimaging in childhood arterial ischaemic stroke: evaluation of imaging modalities and aetiologies. Dev Med Child Neurol 2010; 52:1033-7. [PMID: 20477838 DOI: 10.1111/j.1469-8749.2010.03685.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to describe neuroimaging patterns associated with arterial ischaemic stroke (AIS) in childhood and to differentiate them according to stroke aetiology. METHOD Clinical and neuroimaging (acute and follow-up) findings were analysed prospectively in 79 children (48 males, 31 females) aged 2 months to 15 years 8 months (median 5 y 3 mo) at the time of stroke by the Swiss Neuropaediatric Stroke Registry from 2000 to 2006. RESULTS Stroke was confirmed in the acute period in 36 out of 41 children who underwent computed tomography, in 53 of 57 who underwent T2-weighted magnetic resonance imaging (MRI) and in all 48 children who underwent diffusion-weighted MRI. AIS occurred in the anterior cerebral artery (ACA) in 63 participants and in all cases was associated with lesions of the middle cerebral artery (MCA). The lesion was cortical-subcortical in 30 out of 63 children, cortical in 25 out of 63, and subcortical in 8 of 63 children. Among participants with AIS in the posterior circulation territory, the stroke was cortical-subcortical in 8 out of 16, cortical in 5 of 16, and thalamic in 3 out of 16 children. INTERPRETATION AIS mainly involves the anterior circulation territory, with both the ACA and the MCA being affected. The classification of Ganesan is an appropriate population-based classification for our Swiss cohort, but the neuroimaging pattern alone is insufficient to determine the aetiology of stroke in a paediatric population. The results show a poor correlation between lesion pattern and aetiology.
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Affiliation(s)
- Sarah Buerki
- University Children's Hospital Berne, Switzerland
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