[P1-210] Three Cases of Pediatric Cerebral Infarction Caused by Different Mechanism
[Introduction] Pediatric cerebral infarction (PCI) is less common than adult infarction. Infections and vascular malformations cause many PCIs. We report on three patients with PCIs attributable to different causes.
[Case 1] A 5-month-old boy presented with high fever and right hemiplegia. Head diffusion magnetic resonance imaging (MRI-DWI) revealed an extensive high-intensity area (HIA) around the left basal ganglia. The distal portions of the left middle cerebral artery were not evident on magnetic resonance angiography (MRA). The thrombin-antithrombin complex (TAT) level was high, suggesting that the infarction may have been triggered by infection, followed by vessel inflammation.
[Case 2] A 4-year-old boy experienced persistent esophageal stenosis after a radical operation to treat esophageal atresia. On the day following his fourth esophageal balloon dilation, he presented with left hemiplegia and involuntary movement. MRI-DWI revealed an HIA in the right frontal lobe, but MRA showed no significant findings. We conclude that the general pressure delivered to the left atrium upon esophageal ballooning may have created blood clots.
[Case 3] A 12-year-old girl presented with sudden severe headache, unconsciousness, and hemiplegia. MRI-DWI revealed an HIA in the right basal ganglia. MRA showed that the right middle cerebral artery was attenuated. MR plaque imaging revealed a flap-like structure in this region. She was diagnosed with a PCI attributable to left middle cerebral artery dissection.
[Discussion] All of these clinical features are closely associated with the causes of PCI. We report on our findings and review the literature.
[Case 1] A 5-month-old boy presented with high fever and right hemiplegia. Head diffusion magnetic resonance imaging (MRI-DWI) revealed an extensive high-intensity area (HIA) around the left basal ganglia. The distal portions of the left middle cerebral artery were not evident on magnetic resonance angiography (MRA). The thrombin-antithrombin complex (TAT) level was high, suggesting that the infarction may have been triggered by infection, followed by vessel inflammation.
[Case 2] A 4-year-old boy experienced persistent esophageal stenosis after a radical operation to treat esophageal atresia. On the day following his fourth esophageal balloon dilation, he presented with left hemiplegia and involuntary movement. MRI-DWI revealed an HIA in the right frontal lobe, but MRA showed no significant findings. We conclude that the general pressure delivered to the left atrium upon esophageal ballooning may have created blood clots.
[Case 3] A 12-year-old girl presented with sudden severe headache, unconsciousness, and hemiplegia. MRI-DWI revealed an HIA in the right basal ganglia. MRA showed that the right middle cerebral artery was attenuated. MR plaque imaging revealed a flap-like structure in this region. She was diagnosed with a PCI attributable to left middle cerebral artery dissection.
[Discussion] All of these clinical features are closely associated with the causes of PCI. We report on our findings and review the literature.