Elsevier

Pediatric Neurology

Volume 38, Issue 2, February 2008, Pages 126-129
Pediatric Neurology

Case report
Ischemic Stroke and Excellent Recovery After Administration of Intravenous Tissue Plasminogen Activator

https://doi.org/10.1016/j.pediatrneurol.2007.10.006Get rights and content

Intravenous tissue plasminogen activator has become a mainstream treatment for ischemic hyperacute stroke in the adult population. Its safety and efficacy remain undetermined in the pediatric population. We present a teenager who was hospitalized with left-sided paralysis, and with decreased sensations on the left side. Head computed tomography indicated hyperdensity in the middle cerebral artery region, which confirmed the diagnosis of acute ischemic stroke. Her score on the National Institutes of Health stroke scale was 11. She received intravenous tissue plasminogen activator without any complications. At a follow-up visit 5 months after the stroke, the patient manifested mild apraxia in her left hand and mild expressive amusia. This case underscores the need for emergency head imaging in the pediatric population to establish a diagnosis. The excellent recovery in our patient indicates the need to establish thrombolytic treatment as an option for acute stroke in pediatric populations. It also suggests that tissue plasminogen activator can be used safely and effectively, even in pediatric populations. However, further studies are needed to establish the adequate dosage and adverse-effect profile in pediatric populations.

Introduction

Acute ischemic stroke is an emergently diagnosed and treated condition in the adult population. The Food and Drug Administration of the United States has approved tissue plasminogen activator as a treatment for acute ischemic stroke in patients aged ≥18 years presenting within 3 hours of the onset of signs of stroke. There are no data available regarding tissue plasminogen activator for pediatric stroke. We present a teenage girl who presented with an acute stroke and was given intravenous tissue plasminogen activator, based on criteria used for the adult population [1].

Section snippets

Case Report

A 15-year-old, right-handed, white female presented to the emergency room at Virginia Commonwealth University Health System with a sudden onset of left-sided paralysis, left-sided facial weakness, and decreased sensations in her left arms and leg. Before the onset of symptoms, the patient had been running track for 45 minutes, experienced dizziness, and fell to the ground. She was then observed to have left-sided weakness. The patient was brought to the emergency room via ambulance within 1

Discussion

In pediatric patients, the incidence of stroke involves about 2-13 per 100,000, when neonatal strokes are excluded [2], [3]. Common etiologies of childhood stroke include sickle-cell disease, cardiac diseases, Moya Moya disease, prothrombotic disorders, post-varicella vasculopathy, anti-phospholipid antibodies, extracranial arterial dissections, and metabolic and mitochondrial disorders [4], [5], [6]. Cardiac diseases account for about 25-27% of cases of stroke. These include congenital

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