Acute Pontine Ischemic Stroke in a Healthy Child With Intracranial Vasculopathy

Area of Science:

• Neurology
• Pediatric Neurology
• Vascular Neurology

Background:

• Pediatric stroke is a significant cause of long-term disability.
• Identifying the etiology of stroke in children is crucial for management and prognosis.
• Mineralizing microangiopathy typically affects the anterior circulation in young children following minor head trauma.

Observation:

• An 8-year-old boy presented with acute neurological deficits including altered mental status, facial droop, and hemiplegia.
• Magnetic resonance imaging revealed acute ischemic infarction in the left pons.
• Computed tomographic angiography identified a calcification at the origin of a basilar artery perforating artery.

Findings:

• The patient's stroke occurred after playing in an inflatable bouncer, with no reported head trauma.
• Extensive workup excluded infectious, inflammatory, hypercoagulable, and other vascular causes.
• A calcification in a posterior circulation perforating artery was identified as the likely cause, a presentation not previously described.

Implications:

• This case suggests that minor, unobserved trauma may precipitate stroke in children with underlying vascular calcifications.
• It expands the known spectrum of mineralizing microangiopathy to include the posterior circulation and previously healthy school-age children.
• Further research is needed to understand the pathogenesis and prevalence of such calcifications in pediatric stroke.