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Acute hemiplegia in one infant
C Ciofu1, I Gherghina, I Craiu
1Institute for Assistance of Mother and Children Care, Bucharest, Romania.
Insights
A 9-month-old infant experienced stroke due to familial hypercholesterolemia. Early diagnosis and management led to favorable outcomes, with residual hemiparesis.
Area of Science:
- Neurology
- Pediatrics
- Genetics
Background:
- Familial hypercholesterolemia (FH) is a genetic disorder characterized by high cholesterol levels.
- Cerebrovascular events, such as stroke, are rare in infants but can occur in the context of severe dyslipidemias.
- Early identification and management of risk factors are crucial for preventing severe complications.
Observation:
- A previously healthy 9-month-old obese infant presented with sudden hyperthermia, seizures, and focal neurological deficits including left facial nerve palsy.
- Cranial imaging revealed temporal-parietal infarction, suggestive of Sylvian artery occlusion.
- The infant had a history of familial hypercholesterolemia (type IIA dyslipidemia).
Findings:
- Cerebral infarction in an infant with familial hypercholesterolemia was diagnosed.
- Infectious etiologies such as cerebral abscess and herpetic encephalitis were ruled out through clinical and serologic evaluation.
- Treatment included parenteral antibiotics, anticonvulsants, and antiedematous therapy.
Implications:
- This case highlights the importance of considering genetic lipid disorders in the differential diagnosis of stroke in infants.
- Aggressive management of dyslipidemia and associated risk factors may be critical in preventing recurrent cerebrovascular events.
- Further research into the long-term neurological outcomes and management strategies for pediatric stroke secondary to FH is warranted.
Abstract:
A previously healthy 9-month-old girl, obese (12,500 gm) with sudden onset of hyperthermia (40 degrees C), generalized tonic-clonic seizures, followed by focal seizures, drowsiness, left facial nerve palsy, left lagophthalmos and mydriasis is presented. CT-scan and MRI suggested temporal-parietal infarction due to Sylvian artery occlusion in a 9-month-old infant with familial hypercholesterolemia (type 2 A dyslipidemia). The possibility of a cerebral abscess or herpetic encephalitis was considered. Negative clinic and serologic results excluded this diagnosis. The management of the symptomatology was made with parenteral antibiotics, anticonvulsive and antioedematous cerebral therapy. Favourable evolution with residual left hemiparesis after 30 days, when the child was discharged. CT-scan reevaluation (after 5 months of evolution) showed a hypodense temporal-parietal area abnormality due to a right ischemic infarction.