Stroke in adolescent patient requiring mechanical thrombectomy: A case report

Abstract

Background

Strokes are rare in pediatric patients, however approximately 80% have an identifiable cause. Risk factors for pediatric stroke include the typical atherosclerotic risk factors for adults, but also unique pediatric conditions such as congenital heart diseases, hematological diseases, vasculitis, inflammatory conditions, and trauma. Treatment for pediatric stroke is also much less researched and often extrapolated from adults. Here we present a case of a large vessel stroke in a pediatric patient, with no identifiable cause, treated successfully with mechanical thrombectomy.

Case Report

This case report describes a 12-year-old female who had an ischemic stroke of an unknown etiology. Her case demonstrates a classic stroke presentation and intervention, presenting with acute onset of hemiparesis, facial asymmetry, and dysarthria. Code stroke was promptly activated in the Emergency Department and CTA showed a middle cerebral artery thrombus. She underwent mechanical thrombectomy with Interventional Radiology 4 h after her last known well. Although 78% of pediatric patients have long-standing neurological deficits following ischemic stroke, this patient made a full recovery without long-term neurological deficits. Despite a thorough workup with Pediatric Cardiology, Hematology, and Neurology, the cause of her stroke was never identified.

Why should an emergency physician be aware of this?

The case of idiopathic ischemic stroke in an adolescent patient is an unusual occurrence. Being able to identify these patients presenting to the Emergency Department and ensuring protocols are in place is critical for generating successful outcomes, as evidenced by this case. The complete resolution of her symptoms also demonstrates the potential role of neuroplasticity in pediatric brain recovery.