Hyperhomocysteinemia as a Cause of Acute Ischemic Stroke in a Four-Year-Old Child: A Report of a Rare Case

Abstract

Homocysteine is a type of amino acid that isn't genetically encoded by the human body. This amino acid is capable of causing oxidative damage to the endothelial cells, leading to the onset of thrombosis. Moreover, it can also inflict harm to neurons by activating pro-apoptotic factors, causing DNA damage, and inducing oxidative stress, as observed in various animal models and cell cultures. This case report highlights a four-year-old girl who exhibited signs of an ischemic stroke. The neurological examination revealed several symptoms, including anisocoria, decreased tone, decreased power, absent reflexes on the right upper and lower extremity, and hyper extensor plantar response, accompanied by upper motor neuron seventh cranial nerve palsy. An MRI scan further confirmed the presence of an ischemic stroke in the left middle cerebral artery territory. After a thorough evaluation, the probable cause of this condition was identified as severe homocysteine elevation.

Keywords: homocysteine; hyperhomocysteinemia; ischemic stroke; pediatric stroke; stroke.

Figure 1. T2 weighted MRI in axial (A) and sagittal (B) section showing hyperintensity in the left middle cerebral artery distribution, that is, left temporal, parietal, frontoparietal, and parietooccipital regions.

Figure 2. Homocysteine metabolism

Picture credits: Wikipedia