PB0310 - Arterial Ischemic Stroke Related to Minor Head Trauma: A Report of Five Pediatric Cases

Background: Arterial ischemic stroke (AIS) can occur after a head/neck trauma. More than 90% are minor head trauma (MHT), rarely associated with brain injury or long term neurologic sequelae.

Aims: We present five pediatric cases to draw attention to the AIS related to MHT.

Methods: Cases admitted to our hospital between July 2022 and December 2022 were included.

Results: Case 1: A boy aged 9 months-old fell from a sofa onto a floor. Six hours later, he developed a left sided hemiparesis/facial paralysis. AIS involving the right posterior putamen-internal capsule was demonstrated. Case 2: A girl aged 13 months-old fell from a sofa onto a floor. Two days later, she developed a left sided hemiparesis. AIS findings at right posterior putamen/corona radiata were present. Case 3: A boy aged 4 years-old had trisomy 21. He ran headlong into a door. Seven hours later, he developed a left sided hemiparesis/facial paralysis/aphasia/anisocoria. Occlusion of the middle cerebral artery/AIS features at right parietotemporal region with a shift to the left were present. Case 4: A girl aged 3 years-old fell onto the floor. Two days later, she developed a right sided hemiparesis/facial paralysis. Occlusion/AIS features involving left frontal cortical/subcortical area/left internal carotid artery/middle cerebral artery/anterior cerebral artery were demonstrated. Case 5: A boy aged 5 years-old hit his head to a bar. He developed dysphasia/a right sided hemiparesis/facial paralysis several hours later. AIS features at left vertebral artery/anterior thalamic regions were present.
Enoxaparin/prophylactic acetylsalicylic acid treatments were given to all. Two patients, who developed diffuse cerebral edema due to malignant middle cerebral artery infarction underwent hemicraniectomy; both had neurologic sequelae of unilateral hemiparesis on follow-up.

Conclusion(s): The frequency of AIS due to a MHT may be underestimated; presentation of five cases in a six-month period showed us that it may not be seen rarely.