Coronavirus disease 2019 associated stroke in a toddler – A case report

Background: Stroke, an infrequent entity in children, usually presents with headache, reduced cognition, and seizures as frequent findings. The association of paediatric stroke with Coronavirus disease 2019 (COVID-19) is unknown with only a hand full of postulated hypotheses till date. Clinical Description: A 2-year-old child with sudden onset focal neurological deficits and high COVID antibody titters has been reported soon after a brief episode of cough and cold. Magnetic resonance imaging brain suggested infarct in posterior cerebral circulation. All other inflammatory markers and prothrombotic work-up were normal pointing toward a territorial affliction. Management: Child responded well to anticoagulants (low molecular weight heparin and aspirin) with complete neurological recovery. Conclusion: Possibility of COVID-19 associated regional endotheliitis is very high in the aforesaid toddler. Our case is the youngest reported case of paediatric stroke with a possible association with COVID-19.

Retinal vein occlusion with cerebral infarction in a preterm neonate: a case report

Background Retinal vein occlusion (RVO) is a common disease that causes blindness in elderly patients, and cerebral infarction is also a severe disorder impairing the health of individuals. Both diseases are not common in neonates and are related to thrombosis. To date, only one case of simultaneous occurrence of RVO with intracranial haemorrhage in a full-term neonate has been reported. Case presentation A preterm neonate was diagnosed with cerebral infarction and RVO. Retinal haemorrhage and macular oedema were detected in the left eye after the onset of ipsilateral stroke. Although the retinal conditions in this case resolved spontaneously without ocular treatment, the long-term effect on visual function is still unknown. Conclusions Given that ocular fundus examinations are rarely performed in paediatric stroke patients, a screening fundus examination in these newborns with stroke might be worth considering.

Stents for progressively symptomatic paediatric intracranial arterial dissection

Arterial dissection is an uncommon cause of paediatric stroke. Medical therapy remains first-line for treatment. There are few reports of neurovascular stents for paediatric intracranial arterial dissection. Two adolescents presented with neurological deficits and CT angiography concerning for supraclinoid internal carotid artery stenosis. The diagnosis of dissection was secured through a combination of vessel wall MRI and digital subtraction angiography. The patients experienced progressive ischaemic symptoms, despite medical management including anticoagulation, and required stenting. The stents used were a Neuroform EZ and an Atlas. Both patients recovered to Modified Rankin Scale (mRS) 0 and had restored vessel calibre on 6-month follow-up digital subtraction angiography. Neurovascular stents can be used to treat progressively symptomatic intracranial arterial dissections in the paediatric population if medical therapy fails.

Stents for progressively symptomatic paediatric intracranial arterial dissection

Arterial dissection is an uncommon cause of paediatric stroke. Medical therapy remains first-line for treatment. There are few reports of neurovascular stents for paediatric intracranial arterial dissection. Two adolescents presented with neurological deficits and CT angiography concerning for supraclinoid internal carotid artery stenosis. The diagnosis of dissection was secured through a combination of vessel wall MRI and digital subtraction angiography. The patients experienced progressive ischaemic symptoms, despite medical management including anticoagulation, and required stenting. The stents used were a Neuroform EZ and an Atlas. Both patients recovered to Modified Rankin Scale (mRS) 0 and had restored vessel calibre on 6-month follow-up digital subtraction angiography. Neurovascular stents can be used to treat progressively symptomatic intracranial arterial dissections in the paediatric population if medical therapy fails.

Delayed mid-basilar artery stenosis following paediatric acute mechanical thrombectomy: a rare complication from a rare case

There is limited literature on the use of mechanical thrombectomy with stent-retrievers in paediatric stroke, especially in the posterior circulation. We report a paediatric case of acute basilar artery occlusion successfully treated by mechanical thrombectomy using stent-retriever but complicated by delayed basilar artery stenosis. This case emphasises prudent selection of thrombectomy device and meticulous long-term follow-up when employed in paediatric stroke.