[Clinical characteristics and prognosis of basal ganglia infarction following minor trauma with basal ganglia calcification in children].

Abstract

Pediatric patients with arterial ischemic stroke admitted to Beijing Children's Hospital from September 2015 to September 2024 were retrospectively included. According to the COIST classification criteria, 50 cases were attributed to basal ganglia infarction following minor trauma with basal ganglia calcification. The clinical characteristics, including the nature of the trauma, clinical manifestations, imaging findings, and laboratory tests, were analyzed. The modified Rankin Scale (mRS) was used to evaluate the prognosis. Among the 50 cases, 29 were male (58%), and 21 were females (42%), with a median age of 1.2 (0.9, 2.4) years [M (Q₁, Q₃)]; 84% (42/50) were ≤ 3 years at onset. A clear history of minor trauma was documented in 46 cases (92%), most commonly falls from beds/sofas or tripping; 24 cases developed stroke symptoms within 10 min after trauma, and 13 cases developed symptoms within 1-3 hours. The most common symptoms were hemiparesis, facial palsy , and transient seizures, with incidence rates of 96% (48/50), 72% (36/50), and 30% (15/50), respectively. Bilateral infarcts occurred in 5 cases (10%), unilateral in 45 (90%). All patients had punctate or linear basal ganglia calcification on CT, with 86% (43/50) showing bilateral calcifications; MRI showed basal ganglia infarction in all cases, with periventricular or corona radiata involvement in 38%(19/50) and thalamic involvement in 16%(8/50). Elevated aspartate aminotransferase(AST) was observed in 20 patients (40%). At discharge, mRS score showed that 50% (25/50) had a favorable prognosis; after a mean follow-up of (4.6±2.5)years, 97.8%(45/46) had a good prognosis. Basal ganglia infarction following minor trauma with basal ganglia calcification predominantly occurs in children under 3 years old. The onset occurs after minor trauma, typically presenting with hemiplegia, facial paralysis, and seizures. Head CT scans reveal calcifications in the basal ganglia, and infarcts may involve the basal ganglia, periventricular and corona radiata, and thalamus, with a minority showing bilateral infarcts. The long-term prognosis is favorable.