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Updated: Jun 25, 2025
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Intravenous Thrombolysis for Pediatric Ischemic Stroke Secondary to Cancer Therapy-related Cardiac Dysfunction
Futoshi Eto1, Tomohisa Nezu1, Hideaki Sakahara1
1Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan.
Insights
A child with Ewing sarcoma experienced cardioembolic stroke (CES) due to cancer therapy-related cardiac dysfunction (CTRCD). Intravenous thrombolysis successfully restored blood flow, leading to a full neurological recovery.
Area of Science:
- Pediatric Oncology
- Cardiology
- Neurology
Background:
- Cancer therapy-related cardiac dysfunction (CTRCD) is a serious complication of chemotherapy.
- Cardioembolic stroke (CES) in pediatric patients is rare but can have devastating consequences.
- Ewing sarcoma treatment often involves cardiotoxic agents like doxorubicin.
Purpose of the Study:
- To report a case of pediatric CES secondary to CTRCD.
- To evaluate the efficacy of intravenous thrombolysis in this specific clinical scenario.
- To discuss the potential role of reperfusion therapy in pediatric CES.
Main Methods:
- Case report of an 11-year-old boy with Ewing sarcoma.
- Diagnosis of CES and CTRCD using MRI and echocardiography.
- Treatment with intravenous thrombolysis.
Main Results:
- Successful recanalization of the occluded left middle cerebral artery M3 segment.
- Significant improvement in left ventricular dysfunction.
- Complete neurological recovery with no deficits at discharge.
Conclusions:
- Intravenous thrombolysis may be an effective treatment for pediatric CES secondary to CTRCD.
- Early recognition and intervention are crucial for favorable outcomes.
- Further research is needed to establish reperfusion therapy guidelines for pediatric CES.
Abstract:
An 11-year-old boy developed cardioembolic stroke (CES) and cancer therapy-related cardiac dysfunction (CTRCD). He originally developed Ewing sarcoma and was treated with high-dose chemotherapy including doxorubicin. On admission, he had severe aphasia, and magnetic resonance imaging showed occlusion of the left middle cerebral artery M3 segment. Transthoracic echocardiography revealed severe left ventricular dysfunction and a mobile thrombus at the left ventricular apex. Intravenous thrombolysis was administered, and effective recanalization was achieved. The patient did not exhibit any neurological deficits during discharge. Reperfusion therapy for pediatric patients has not yet been established; however, it may be effective for CES secondary to CTRCD.
