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Transient cerebral arteriopathy in infancy associated with enteroviral infection
Pascale Ribai1, Corinne Liesnard, Georges Rodesch
1Department of Paediatric Neurology, Université Libre de Bruxelles, Hôpital Erasme, Belgium.
Insights
A rare enteroviral infection caused transient cerebral arteriopathy in an infant, leading to temporary stroke-like symptoms. Prompt cerebrospinal fluid analysis is crucial for diagnosing unclear pediatric ischemic stroke cases.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Vascular Neurology
Background:
- Transient cerebral arteriopathy of childhood (TCA) is a rare condition causing temporary neurological deficits in children.
- Ischemic stroke in children often presents diagnostic challenges, necessitating thorough etiological investigation.
Observation:
- An 18-month-old boy experienced acute aphasia and right hemiplegia, which resolved spontaneously.
- Recurrent transient neurological deficits and seizures occurred, accompanied by medial cerebral artery stenosis and ischemic lesions on imaging.
Findings:
- Cerebrospinal fluid analysis revealed pleocytosis and confirmed an active enteroviral infection.
- Magnetic resonance angiography demonstrated normalization of arterial lesions, consistent with TCA.
Implications:
- This case highlights the first reported association between enteroviral infection and TCA.
- Emphasizes the importance of cerebrospinal fluid analysis in pediatric ischemic stroke of unknown origin.
Abstract:
We report the case of an 18-month-old boy who presented aphasia and right hemiplegia of acute onset. The neurological deficit completely resolved after a few hours, but identical transient neurological deficits and seizures occurred during the following days. Imaging showed proximal stenosis of the medial cerebral artery and deep ischaemic lesions in the territory of this artery. Analysis of the cerebrospinal fluid showed pleocytosis and an active enteroviral infection with positive RNA detection. The evolution was consistent with transient cerebral arteriopathy of childhood as magnetic resonance angiography showed normalization of the arterial lesions. This is the first report of an enteroviral infection associated with this entity. We want to stress the importance of performing a cerebrospinal fluid analysis when an ischaemic stroke of unclear aetiology occurs in a child.