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Basal ganglia and thalamic infarction in children. Cause and clinical features
M C Brower1, N Rollins, E S Roach
1Division of Pediatric Neurology, University of Texas Southwestern Medical Center, Dallas, USA.
Insights
Pediatric ischemic infarctions in the basal ganglia, internal capsule, or thalamus commonly present with hemiplegia. Most children with unilateral lesions show a good prognosis, with diverse risk factors and large artery occlusion being common.
Area of Science:
- Pediatric neurology
- Neuroimaging
- Vascular neurology
Background:
- Study details signs, symptoms, and radiographic findings in 36 children with ischemic infarctions.
- Infarctions affected the basal ganglia, internal capsule, or thalamus.
Purpose of the Study:
- To characterize the clinical and radiographic features of pediatric ischemic infarctions.
- To identify presenting symptoms and outcomes.
- To explore risk factors and vascular involvement.
Main Methods:
- Retrospective analysis of 36 pediatric patients (newborn to 13 years).
- Utilized computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and conventional cerebral angiography.
- Assessed lesion laterality (unilateral/bilateral) and location.
Main Results:
- Hemiplegia was the most frequent presenting symptom (30/36).
- Other symptoms included aphasia, seizures, altered consciousness, and hemisensory changes.
- Bilateral lesions often presented with altered mental status; lesion location did not predict presentation.
Conclusions:
- Risk factors for pediatric basal ganglia infarction are varied; systemic hypertension is not a major factor.
- Vascular occlusion typically involved large arteries with secondary smaller artery occlusion.
- Children with single, unilateral infarctions generally have a favorable prognosis.
Background:
We present the signs, symptoms, and radiographic features of 36 children with ischemic infarctions of the basal ganglia, internal capsule, or thalamus.
Patients And Methods:
The series includes 14 males and 22 females ranging in age from newborn to 13 years. Twenty-seven patients were evaluated with computed tomography, 34 with magnetic resonance imaging, 16 with magnetic resonance angiography, and 10 with conventional cerebral angiography. Thirty patients had unilateral lesions (16 left, 14 right) and 6 had bilateral infarctions.
Results:
The most common presenting symptom was hemiplegia (30 of 36). Other children presented with aphasia (5 of 36), seizures (5 of 36), altered consciousness (5 of 36), and hemisensory changes (5 of 36). Four of 6 patients with bilateral lesions presented with altered mental status, but the location of a unilateral infarction within the thalamus or basal ganglia did not predict the clinical presentation.
Conclusions:
The risk factors for basal ganglia infarction in children are diverse, but systemic hypertension does not play a major role in children. The vascular occlusion often occurred in the large arteries, with secondary occlusion of the smaller penetrating arteries. Most children with a single unilateral infarction have a good prognosis.