[P1-208] Pediatric Ischemic Stroke With Heart Disease: Case Series
[Introduction]
Children with congenital cyanotic heart disease is more likely to have stroke compared with children who have acyanotic heart disease. Cardiac defect is a strong risk factor for stroke. One of the unique mechanism of stroke in cyanotic congenital heart disease is paradoxical embolism, caused by an abnormal venous-to-arterial communication.
[Cases]
We report two cases of stroke ischemic in cyanotic congenital heart disease patients. The first case is a 13-year-old boy with double outlet right ventricle. He experienced sudden right hemiparesis, seven days prior to admission. Cerebral CT scan showed multiple ischemic lesions in left parietal dan right frontal lobe, while cerebral CT angiography revealed occlusion of left cerebral media artery (M2-M3 segment). He was then given long-term anticoagulant treatment with warfarin. The neurological deficit improved but not significantly and rapidly. The second case is a 9-year-old girl with ostium secundum atrial septal defect, severe mitral, and tricuspid regurgitation. She experienced sudden left hemiparesis and left central facial palsy 15 hours prior to admission. Cerebral CT scan showed multiple ischemic lesions in right basal ganglia and left frontal lobe. She was treated initially with intravenous unfractionated heparin for five days. On the fifth day, her neurological deficit improved significantly and the therapy was then substituted with warfarin.
[Conclusion]
The outcome of ischemic stroke in pediatric heart disease depends on several factors, such as the appropriate time of treatment after onset of symptoms, and type of heart disease.
Children with congenital cyanotic heart disease is more likely to have stroke compared with children who have acyanotic heart disease. Cardiac defect is a strong risk factor for stroke. One of the unique mechanism of stroke in cyanotic congenital heart disease is paradoxical embolism, caused by an abnormal venous-to-arterial communication.
[Cases]
We report two cases of stroke ischemic in cyanotic congenital heart disease patients. The first case is a 13-year-old boy with double outlet right ventricle. He experienced sudden right hemiparesis, seven days prior to admission. Cerebral CT scan showed multiple ischemic lesions in left parietal dan right frontal lobe, while cerebral CT angiography revealed occlusion of left cerebral media artery (M2-M3 segment). He was then given long-term anticoagulant treatment with warfarin. The neurological deficit improved but not significantly and rapidly. The second case is a 9-year-old girl with ostium secundum atrial septal defect, severe mitral, and tricuspid regurgitation. She experienced sudden left hemiparesis and left central facial palsy 15 hours prior to admission. Cerebral CT scan showed multiple ischemic lesions in right basal ganglia and left frontal lobe. She was treated initially with intravenous unfractionated heparin for five days. On the fifth day, her neurological deficit improved significantly and the therapy was then substituted with warfarin.
[Conclusion]
The outcome of ischemic stroke in pediatric heart disease depends on several factors, such as the appropriate time of treatment after onset of symptoms, and type of heart disease.