Case Report
Stroke in a Child Safely Treated with Intravenous Tissue Plasminogen Activator and Edaravone, a Free Radical Scavenger

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An 11-year-old female felt discomfort in her head, and left hemispheric syndrome occurred shortly thereafter. At presentation, her National Institutes of Health stroke scale (NIHSS) score was 13, and a magnetic resonance imaging scan revealed acute brain infarction in the left thalamus. She was immediately treated with the intravenous administration of tissue plasminogen activator (IV t-PA) followed by edaravone, a free radical scavenger. Two hours after IV t-PA, her symptoms dramatically resolved and her NIHSS score decreased to 5. No adverse events were observed. She was the youngest patient treated with IV t-PA in Japan, and would be the youngest treated in most developed countries. An optimal treatment for stroke in children has not been established, and this case highlights the urgent need to examine the safety and efficacy of IV t-PA and edaravone therapy for ischemic stroke in children.

Section snippets

Case Report

An 11-year-old, right-handed Japanese female was participating in an outdoor activity, went to the bathroom, and had a bowel movement. Thereafter, she felt discomfort in her head followed by posterior headache and dizziness. Her mother was aware that she had right hemiparesis and that she was unable to respond properly. An ambulance was called, and she presented to the emergency department of a secondary emergency hospital. Because the patient had experienced only a single episode of fibrile

Discussion

Symptoms of stroke mimic those of epilepsy and other neurologic disorders, and these disorders are much more frequent than stroke in children. Making the diagnosis of stroke in children within 3 hours from onset is a challenge. Early MRI findings greatly helped us to diagnose arterial ischemic stroke in the current case, and MRI should be performed immediately in such a case.

We assumed that the thalamic lesion caused diaschisis to the left hemisphere and partly affected the internal capsule. We

Acknowledgment

The authors thank Ms. Hisayo Saito and Mayumi Wakabayashi for preparation of this manuscript. We also thank Drs. Yuko Yokomizo and Toru Kurokawa for care in the rehabilitation hospital.

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