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Reversible vascular changes in children with cerebral infarction
Kenichiro Kobayashi1, Mieko Yoshioka, Masaru Yamakawa
1Department of Pediatrics, Kobe City General Hospital, Japan. kenichiro_kobayashi@medical.general.hp.city.kobe.jp
Insights
This case study highlights a rare childhood cerebral infarction in a 4-year-old boy. Longitudinal angiographic follow-up revealed spontaneous recovery and regression of vascular changes, emphasizing its importance in idiopathic cases.
Area of Science:
- Neurology
- Pediatric Neurology
- Vascular Neurology
Background:
- Childhood cerebral infarction is a rare but serious neurological event.
- Idiopathic cases, without identifiable risk factors, present diagnostic challenges.
Observation:
- A 4-year-old male presented with acute right hemiplegia, facial palsy, and dysarthria.
- Imaging revealed left middle cerebral artery infarction and stenosis in left cerebral arteries.
- The child experienced spontaneous recovery with minimal sequelae.
Findings:
- Magnetic resonance angiography showed reversible vascular changes in the left cerebral arteries.
- Complete regression of arterial narrowing was observed 2 months post-stroke.
- No stroke recurrence was noted during a 2-year follow-up period.
Implications:
- This case underscores the necessity of serial angiographic monitoring in pediatric stroke.
- Reversible cerebral vasoconstriction syndrome (RCVS) or similar vasculopathies should be considered in idiopathic childhood stroke.
- Longitudinal follow-up is crucial for understanding the natural history and prognosis of childhood cerebral infarction.
Abstract:
A case of cerebral infarction in a 4-year-old male is described. The child presented with an acute onset of right hemiplegia, central facial palsy, and dysarthria. He had no predisposing factors for cerebral infarction. A computed tomography scan showed a diffuse low-density area in the territory of the left miiddle cerebral artery. Magnetic resonance angiography disclosed multiple irregular narrowings in the left anterior and middle cerebral arteries. He recovered spontaneously from the stroke with minimal long-term complications, and repeated angiography disclosed a complete regression of the vascular changes 2 months after the stroke. There was no recurrence of stroke after 2-year follow-up. This case demonstrates the importance of longitudinal angiographic follow-up in childhood cerebral infarction of idiopathic origin.