Recurrent arterial ischemic stroke with good response to mycophenolate mofetil

Area of Science:

• Pediatric Neurology
• Immunology
• Vascular Neurology

Background:

• Childhood arterial ischemic stroke is uncommon and often diagnosed late.
• Accurate diagnosis of the underlying cause is crucial for effective treatment of pediatric stroke.
• Primary angiitis of the central nervous system (PACNS) requires treatment with corticosteroids and immunosuppressants.

Observation:

• A pediatric case of PACNS presented with recurrent strokes and progressive arteriopathy despite initial treatment.
• The patient experienced relapses after treatment with corticosteroids, cyclophosphamide, and azathioprine.
• Disease stabilization and a four-year relapse-free period were achieved with mycophenolate mofetil and low-dose corticosteroids.

Findings:

• Mycophenolate mofetil demonstrated efficacy in managing a relapsing pediatric PACNS case.
• Combination therapy with mycophenolate mofetil and corticosteroids provided sustained disease control.
• This case highlights the potential of mycophenolate mofetil in refractory PACNS.

Implications:

• This case suggests mycophenolate mofetil as a potential therapeutic option for relapsing pediatric PACNS.
• Further research is needed to establish treatment guidelines for childhood PACNS.
• Effective management of pediatric PACNS can lead to improved long-term outcomes and reduced stroke recurrence.