Athletics, minor trauma, and pediatric arterial ischemic stroke

Abstract

Pediatric arterial ischemic stroke may occur as the result of trivial head or neck trauma sustained during a sports activity. We describe three cases of sports-related stroke in previously healthy school-age children and discuss acute and long-term stroke care. Possible mechanisms of sports-related stroke are addressed, as is evaluation for cause of stroke in children. In one of the reported cases, the child was found to have a vertebral artery dissection as the cause of his stroke, but no definitive cause of stroke was identified in the other two cases despite extensive evaluation. The advisability and timing of returning to athletic activities after stroke is also discussed. Many children with sports-related stroke are initially seen by a sports trainer, a pediatrician, or an ER physician. Thus, it is particularly important that these professionals are aware of the possibility of ischemic stroke occurring after even mild athletic injury. Childhood stroke may result from injuries sustained during athletic activities and should be considered when a child has acute focal neurologic signs.

Fig. 1

For case 1, diffusion-weighted MRI (a) shows faint bright signal, restricted diffusion, in the right basal ganglia. Apparent-diffusion coefficient image (b) is correspondingly dark, confirming acute ischemic infarction. White arrows indicate lesion site

Fig. 2

For case 3, diffusion-weighted MRI shows restricted diffusion in the right cerebellum, left medial medulla (a) and left posterior parietal lobe (b) with corresponding dark signal on apparent-diffusion coefficient images (c and d). White arrows indicate lesion sites. In e, digital subtraction angiography shows a right vertebral artery dissection with intraluminal clot (black arrow)