Hyperacute therapies for childhood stroke: a case report and review of the literature

Abstract

Objective. The optimal management of pediatric patients with arterial ischemic stroke (AIS) is not known. Despite this, goal-oriented, time-sensitive therapies geared to rapid reestablishment of arterial blood flow are occasionally applied with beneficial effects. The inconsistent approach to AIS is in part due to a lack of knowledge and preparedness. Methods. Case report of a 12-year-old male with right middle cerebral artery (MCA) occlusion resulting in dense left hemiplegia and mutism and review of the literature. Intervention(s). Mechanical thrombectomy, intra-arterial administration of rt-PA, vasodilators, and platelet inhibitors, and systemic anticoagulation and subsequent critical care support. Results. Restoration of right MCA blood flow and complete resolution of neurologic deficits. Conclusion. We report the gratifying outcome of treatment of a case of AIS in a pediatric patient treated with hyperacute therapies geared to arterial recanalization and subsequent neurologic critical care and review the pertinent literature. Guidelines for the emergency room management of pediatric AIS from prospective, randomized trials are needed.

Figure 1

Diffusion weighted imaging (DWI) showing area of restricted diffusion.

Figure 2

Coronal view of angiography arrow pointing to the area the Middle Cerebral Artery occlusion.

Figure 3

Sagittal view of angiography arrow pointing to the area the Middle Cerebral Artery occlusion.

Figure 4

Sagittal view demonstrating a significant improvement in blood flow after rt-PA Abciximab and nitroglycerin were infused. Arrow points to a small residual occlusion.

Figure 5

Sagittal view demonstrating a significant improvement in blood flow after rt-PA Abciximab and nitroglycerin were infused. Arrow points to a small residual occlusion.

Figure 6

MRI 3 month after the initial insult showing a residual hyperdense signal abnormally in the periventricular region.