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Updated: Jan 19, 2026
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Acute Ischemic Stroke in a Child Successfully Treated with Thrombolytic Therapy and Mechanical Thrombectomy
Renata Souto Silva1, Rita Rodrigues1, Diana Reis Monteiro2
1Neurology Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal.
Insights
Pediatric acute ischemic stroke is rare. This case highlights successful treatment with recombinant tissue plasminogen activator (rTPA) and mechanical thrombectomy in a 4-year-old, emphasizing early diagnosis and intervention for better outcomes.
Area of Science:
- Pediatric Neurology
- Vascular Neurology
- Interventional Neurology
Background:
- Acute ischemic stroke in children is uncommon but leads to significant long-term disability.
- Established adult treatments like thrombolysis and mechanical thrombectomy have limited pediatric evidence.
- Congenital heart disease is a risk factor for stroke in pediatric patients.
Observation:
- A 4-year-old boy with congenital heart disease presented with acute aphasia and hemiplegia.
- CT angiography revealed a left middle cerebral artery thrombus.
- Initial non-contrast CT showed no acute ischemic changes.
Findings:
- Intravenous recombinant tissue plasminogen activator (rTPA) administered 3.5 hours after symptom onset led to initial improvement.
- Mechanical thrombectomy performed 9 hours after symptom onset successfully removed the M1 segment thrombus.
- The patient's Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score improved from 14 to 2 at discharge.
Implications:
- This case demonstrates the feasibility and effectiveness of mechanical thrombectomy and rTPA in pediatric ischemic stroke.
- Early recognition and rapid treatment are crucial for improving neurological outcomes in children with stroke.
- Further research is needed to establish evidence-based guidelines for pediatric stroke interventions.
Abstract:
Acute ischemic stroke in the pediatric population is rare but carries lasting and often lifelong morbidity. Thrombolysis and mechanical thrombectomy are mainstays of care in adults, yet there is very little evidence for these treatments in children. We present the case of a 4-year-old boy with complex congenital heart disease, admitted 30 min after sudden onset of an aphasia and right hemiplegia, scoring 14 on the Pediatric National Institutes of Health Stroke Scale (PedNIHSS). Non-contrast brain computed tomography (CT) showed no evidence of acute ischemia. CT angiogram demonstrated a thrombus in the M1 segment of the left middle cerebral artery. Intravenous recombinant tissue plasminogen activator (rTPA) was infused 3.5 h after onset of symptoms. An improvement was observed in the hour after rTPA, with a PedNIHSS score of 7. Digital subtraction angiography was performed approximately 9 h from the onset of symptoms, showing a complete left M1 occlusion. The patient underwent successful mechanical thrombectomy and was discharged with a PedNIHSS score of 2. This case emphasizes the importance of early recognition to direct children towards rapid diagnosis and hyperacute treatment.
