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Cerebrovascular event, dilated cardiomyopathy, and pheochromocytoma
Maria I Dagartzikas1, Kelly Sprague, Guy Carter
1Department of Child Health, The University of Missouri, Columbia, Missouri 65212, USA.
Insights
A previously healthy adolescent experienced a stroke due to a cardiac thrombus, which was the first sign of dilated cardiomyopathy (DCM) and pheochromocytoma, a rare pediatric presentation.
Area of Science:
- Pediatric Neurology
- Cardiology
- Endocrinology
Background:
- Cerebral infarction in children has diverse etiologies, including cardiac and vascular issues.
- Dilated cardiomyopathy (DCM) can lead to embolic events, but its presentation as the initial manifestation of stroke in pediatrics is undocumented.
- Pheochromocytoma is a rare tumor that can cause cardiovascular complications.
Observation:
- A previously healthy adolescent presented with acute hemiparesis, indicating a cerebrovascular event.
- Diagnostic work-up revealed dilated cardiomyopathy with a left ventricular mural thrombus as the cause of the stroke.
- Further investigation identified pheochromocytoma as the underlying etiology of the DCM.
Findings:
- This case represents the first reported instance of an embolic event from DCM as the presenting sign in a pediatric patient.
- Congestive heart failure and DCM have not previously been reported as the initial presentation of pheochromocytoma in children.
- The study highlights an unusual sequence of medical conditions in a pediatric patient.
Implications:
- This case underscores the importance of considering rare underlying causes for pediatric stroke and cardiomyopathy.
- Early diagnosis and management of pheochromocytoma are crucial to prevent severe cardiovascular complications.
- Further research is warranted to understand the link between pheochromocytoma, DCM, and embolic events in pediatric populations.
Abstract:
Cerebral infarction in children may be the result of various disease processes, including emboli from intracardiac sources, paradoxical emboli from the venous system, sickle cell disease, cyanotic heart disease, vasculitis affecting the carotid or cerebral vascular system, vascular anomalies, and prothrombotic states. We present a previously healthy adolescent who presented with the acute onset of hemiparesis. Work-up revealed a dilated cardiomyopathy with a left ventricular mural thrombus as the etiology of his cerebrovascular event. Although dilated cardiomyopathy (DCM) may predispose to the development of a mural thrombus and subsequent embolic events, there are no previous reports in pediatric-aged patients of the development of an embolic event as the presenting manifestation of DCM. Further investigation of the etiology of the DCM led to the diagnosis of a pheochromocytoma. Congestive heart failure and DCM as the presenting sign of pheochromocytoma has likewise not been reported in a pediatric-aged patient. We review this unlikely sequence of events, the diagnostic evaluation of such patients, and treatment options.