Mineralizing angiopathy presenting with recurrence of basal ganglia stroke following minor head trauma

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Date: April-June 2019
From: Journal of Postgraduate Medicine(Vol. 65, Issue 2)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Case study
Length: 1,581 words
Lexile Measure: 1570L

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Byline: H. Bhardwaj, M. Swami, A. Singh, J. Kaushik

Basal ganglia stroke secondary to mineralizing angiopathy of lenticulostriate arteries is a well-recognized clinical entity following minor head trauma in children. Recurrences are uncommon, and the majority of these recurrences occur within a few months of initial insult. We report a 2-year-old boy who developed recurrence of basal ganglia stroke after a latency of 18 months from the time of first unrecognized insult at 6 months of age. The case brings forth the need to recognize the condition of basal ganglia stroke secondary to mineralizing angiopathy considering the risk of recurrence to occur as far as 18 months after the first stroke.

Introduction

Arterial ischemic stroke is an important cause of neurologic morbidity in neonates and children. The consequences include hemiparesis, intellectual disabilities, and epilepsy. Cerebral arteriopathies contribute to nearly half of the arterial ischemic stroke in children.[1] Basal ganglia stroke in infants, following trivial head trauma, is a well-recognized clinical entity secondary to mineralizing angiopathy of lenticulostriate vessels.[2],[3],[4],[5],[6],[7] It is considered a benign condition with relatively good prognosis. We report a recurrence of basal ganglia stroke in a 2-year-old child after a latency of 18 months following the first insult of minor head injury at 6 months of age.

Case Report

A 2-year-old boy was hospitalized with a sudden onset of decreased movement of the right half of the body. This was preceded by a fall from the bed, 1 hour back. There was no history of fever, loss of consciousness, seizures, or bleeding from any site. Subsequently, he developed intermittent twisting posturing of the right upper and lower limb. Examination revealed reduced muscle power (upper limb 3/5, lower limb 4/5), brisk deep tendon reflexes, and intermittent dystonic posturing in the right upper and lower limb. Rest of the systemic examination was normal. The child had suffered from a similar episode of weakness involving left upper limb and lower limb following fall from bed at 6 months of age that improved over the next few months. He had residual weakness of the left lower limb which was evident while running. There was no significant family history of stroke or any other neurological illness.

His hemoglobin was 8.7 g/dL, and peripheral smear showed microcytic, hypochromic red cells. Review of magnetic resonance imaging (MRI) brain performed at 6 months of age revealed vascular stroke involving the right...

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Gale Document Number: GALE|A584164889