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Successful Mechanical Thrombectomy for Basilar Artery Occlusion in a Seven-Year-Old Male
Nasar Ali1, Mustafa Al-Chalabi1, Hisham Salahuddin1
1Department of Neurology, University of Toledo, Toledo, USA.
Insights
Mechanical thrombectomy is a safe and effective treatment for acute arterial strokes in children, even after severe neurological deficits. This procedure led to significant recovery in a pediatric patient with basilar artery occlusion.
Area of Science:
- Pediatric Neurology
- Vascular Neurology
- Interventional Neuroradiology
Background:
- Acute arterial strokes in children are uncommon but can lead to severe, permanent neurological deficits.
- Mechanical thrombectomy is a proven stroke treatment in adults, but its efficacy and safety in pediatric patients are still under investigation.
Observation:
- A seven-year-old male presented with seizures and severe neurological deficits after a neck injury.
- Brain MRI revealed infarcts in the pons, midbrain, and cerebellum.
- CTA demonstrated left vertebral artery dissection and complete basilar artery occlusion.
Findings:
- Mechanical thrombectomy was performed six hours after symptom onset.
- Successful recanalization of the basilar artery was achieved.
- The patient showed significant neurological recovery, with NIH score improving from 21 to 1.
Implications:
- This case adds to the evidence supporting the efficacy and safety of mechanical thrombectomy in pediatric stroke management.
- Early intervention with mechanical thrombectomy can lead to substantial neurological improvement in children with arterial ischemic stroke.
- Further research is warranted to establish definitive guidelines for mechanical thrombectomy in pediatric stroke populations.
Abstract:
Acute arterial strokes in children are rare but can potentially cause lasting and often permanent neurological deficits. Mechanical thrombectomy has a well-established efficacy and safety profile in adult stroke management, but in the pediatric population, it is yet to be proven efficacious and safe. We present a case of a seven-year-old male who presented with multiple episodes of generalized tonic-clonic seizures after sustaining a neck injury by falling from a trampoline. National Institutes of Health (NIH) on presentation was 21. Neurological exam revealed dilated nonreactive pupils, dysconjugate gaze, severe dysarthria, bilateral ptosis, and movement of upper and lower extremities only to noxious stimuli. Magnetic resonance imaging (MRI) of brain without contrast revealed infarcted areas in the left pons, midbrain, and cerebellar regions. Computed tomographic angiogram (CTA) of head demonstrated left vertebral artery dissection with associated complete occlusion of the distal basilar artery. Successful recanalization was achieved with mechanical thrombectomy six hours after presentation. Mechanical thrombectomy treatment resulted in a significant neurological recovery with NIH of 1. This case supports the growing evidence of the efficacy and safety of mechanical thrombectomy in children.
