A rare cause of stroke in young children: minor head trauma associated with mineralising lenticulostriate angiopathy in three patients

ABSTRACT

Acute basal ganglia infarct following minor head trauma in association with mineralisation of lenticulostriate arteries is an increasingly recognised entity in childhood stroke. Three cases with a classical history and phenotypical features of mineralising angiopathy are described. Case 1 was a 2-year-old girl who presented with acute onset hemiparesis with a same-side upper motor neuron (UMN)-type facial palsy following minor head trauma. Case 2 was a 14-month-old boy who presented with a left side hemiparesis and a left UMN-type facial nerve palsy following a minor fall. Case 3 was an 8-month-old boy who, following a fall from his cot, had a sudden-onset hemiparesis on the right side and deviation of the angle of the mouth to the left. In brain computed tomography, all three cases demonstrated characteristic basal ganglia calcification of the mineralising angiopathy. Magnetic resonance imaging of the brain demonstrated features supportive of acute infarcts in the lentiform nucleus, caudate nucleus and putamen. Two of the patients had iron deficiency anaemia with haemoglobin of 7.0 g/dL and 7.8 g/dL, respectively. On follow-up, Case 1 had mild residual weakness and the other two made a complete recovery. None of the patients had a recurrence of stroke. Basal ganglia stroke with mineralising angiopathy should be considered in toddlers presenting with sudden-onset focal neurological deficits preceded by minor head trauma.

Abbreviations: ADC: apparent diffusion coefficient; CT: computed tomography; DWI: diffusion-weighted imaging; Hb: haemoglobin; IDA: iron deficiency anaemia; MRI: magnetic resonance imaging; SLV: sonographic lenticulostriate vasculopathy; SWI: susceptibility weighted imaging; UMN: upper motor neuron.

KEYWORDS:

• Trauma
• mineralising angiopathy
• stroke
• basal ganglia calcification

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Notes on contributors

Kiruthiga Sugumar

Kiruthiga sugumar is a Senior Resident working at the Department of Pediatrics, JIPMER, Puducherry. Her areas of Interest include Pediatric Neurology and academic general pediatrics

Aakash Chandran Chidambaram

Aakash Chandran Chidambaram is working as a Junior Resident at the Department of Pediatrics, JIPMER, Puducherry. His areas of Interest include Pediatric neurology, Pediatric intenive care and Immunology. He has authored many papers in National and International journals

Bobbity Deepthi

Bobbity Deepthi is Assistant Professor of Pediatrics at JIPMER, Puducherry. She manages a variety of cases with special focus on renal ailments as a part of pediatric nephrology services at JIPMER.She has authored many papers in National and International journals

Sriram Krishnamurthy

Sriram Krishnamurthy is a Professor of Pediatrics at JIPMER. He is a Pediatric Nephrologist who manages a large number children with renal ailments including nephrotic syndrome, renal tubulopathies, glomerulopathies, acute kidney injury and chronic kidney disease. He has authored many papers in National and International Journals

C. G. Delhikumar

C.G Delhikumar is Additional Professsor of Pediatrics at JIPMER, Puducherry. His area of expertise is Pediatric Endocrinology and acdemic general pediatrics. He has authored many papers in National and International journals