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      Post-traumatic ischaemic stroke in a teenager after head trauma: A case report

      case-report

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          Abstract

          Background

          Lacunar strokes in the pediatric population are very uncommon, as well as trauma-induced strokes. It is extremely rare for a head trauma induced ischaemic stroke to occur in children and young adults.

          Case report

          We describe a case of a 13-year-old boy who reported acute ischaemic lesions, and in particular a right basal ganglia ischaemic stroke after falling from a height of 10 m, presumably secondary to the stretching-induced occlusion of the recurrent artery of Heubner, with a favorable outcome.

          Conclusion

          Ischaemic strokes can rarely be subsequent to head trauma in young adults, in relationship with the degree of maturity of the perforating vessels. Although very rare, it is important to avoid the lack of recognition of this condition, thus awareness is necessary.

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          Most cited references24

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          Risk of stroke in children: ethnic and gender disparities.

          Carol Johnston, S. Zhao, Y. Wu … (2003)
          Using a California-wide hospital discharge database, the authors analyzed all first admissions for stroke in children 1 month through 19 years of age from 1991 through 2000. Incidence rates were estimated as the number of first hospitalizations divided by the person-years at risk; case fatality rates were based on in-hospital deaths. The authors identified 2,278 first admissions for childhood stroke, yielding an annual incidence rate of 2.3 per 100,000 children (1.2 for ischemic stroke, 1.1 for hemorrhagic stroke). Compared with whites, black children were at higher risk of stroke (for ischemic stroke, relative risk [RR] 2.59, 95% CI 2.17 to 3.09, p < 0.0001; subarachnoid hemorrhage [SAH], RR 1.59, CI 1.06 to 2.33, p = 0.02; intracerebral hemorrhage [ICH], RR 1.66, CI 1.23 to 2.13, p = 0.0001). Hispanics, however, had a lower risk of ischemic stroke (RR 0.70, CI 0.60 to 0.82, p < 0.0001) and ICH (RR 0.77, CI 0.64 to 0.93, p = 0.0004), whereas Asians had similar risks as whites. Boys were at higher risk for all stroke types than girls (ischemic stroke, RR 1.25, CI 1.11 to 1.40, p = 0.0002; SAH, RR 1.24, CI 1.00 to 1.53, p = 0.047; ICH, RR 1.34, CI 1.16 to 1.56, p = 0.0001). After eliminating cases with coexisting sickle cell disease, excess stroke risk persisted in blacks; after elimination of trauma, excess stroke risk persisted in boys. Case fatality rates were similar among different ethnic groups. Compared with girls, boys had a higher case fatality rate for ischemic stroke (17 vs 12%; p = 0.002) but not for ICH or SAH. Rates of hospitalization for stroke are higher among black children and boys; sickle cell disease and trauma do not fully account for these findings.
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            Recent trauma and acute infection as risk factors for childhood arterial ischemic stroke.

            Brandon Zielinski, Carol Johnston, Paul Hills … (2012)
            Trauma and acute infection have been associated with stroke in adults, and are prevalent exposures in children. We hypothesized that these environmental factors are independently associated with childhood arterial ischemic stroke (AIS). In a case-control study nested within a cohort of 2.5 million children (≤19 years old) enrolled in an integrated health care plan (1993-2007), childhood AIS cases (n = 126) were identified from electronic records and confirmed through chart review. Age- and facility-matched controls (n = 378) were randomly selected from the cohort. Exposures were determined from review of medical records prior to the stroke diagnosis, or the same date for the paired controls; time windows were defined a priori. A medical encounter for head or neck trauma within the prior 12 weeks was an independent risk factor for childhood AIS (odds ratio [OR], 7.5; 95% confidence interval [CI], 2.9-19.3), present in 12% of cases (1.6% of controls). Median time from trauma to stroke was 0.5 days (interquartile range, 0-2 days); post hoc redefinition of trauma exposure (prior 1 week) was more strongly associated with AIS: OR, 39; 95% CI, 5.1-298. A medical encounter for a minor acute infection (prior 4 weeks) was also an independent risk factor (OR, 4.6; 95% CI, 2.6-8.2), present in 33% of cases (13% of controls). No single infection type predominated. Only 2 cases had exposure to trauma and infection. Trauma and acute infection are common independent risk factors for childhood AIS, and may be targets for stroke prevention strategies. Copyright © 2012 American Neurological Association.
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              Outcome after ischaemic stroke in childhood.

              N Shack, Robert E. Isaacs, Susan Hogan … (2000)
              A parental questionnaire was used to investigate the outcome for children who had had ischaemic stroke, who were seen at Great Ormond Street Hospital, London between 1990 and 1996. The results of functional assessments carried out by a physiotherapist and an occupational therapist, and of quantitative evaluations carried out by a neuropsychologist were used for validation where possible. The relationship between clinical and radiological factors and outcome were examined. The children were aged between 3 months and 15 years at the time of stroke (median age 5 years) and the period of follow-up ranged from 3 months to 13 years (median duration 3 years). Of the 90 children for whom data were obtained, 13 (14%) had no residual impairments. Outcome was good in 37 children (40%) and poor in 53 (60%) (defined according to whether impairments interfered with daily life). Agreement, as measured by Cohen's kappa, was good or very good between the parents' responses and the qualitative measures provided by the medical professionals and the therapists, but only fair to moderate for the quantitative measures provided by the neuropsychologists. This may reflect different parental perceptions of the physical and cognitive aspects of outcome. Younger age at time of the stroke was the only significant predictor of adverse outcome.
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                Author and article information

                Contributors
                Davide D'Antini
                Journal
                Journal ID (nlm-ta): Trauma Case Rep
                Journal ID (iso-abbrev): Trauma Case Rep
                Title: Trauma Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2352-6440
                Publication date PMC-release: 04 May 2023
                Publication date Collection: June 2023
                Publication date (Electronic): 04 May 2023
                Volume: 45
                Electronic Location Identifier: 100835
                Affiliations
                Department of Anesthesia and Intensive Care, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Foggia, Italy
                Author notes
                [* ]Corresponding author at: Department of Anesthesia and Intensive Care, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, viale Cappuccini, S. Giovanni Rotondo 71043, Foggia, Italy. d.dantini@ 123456operapadrepio.it
                Article
                Publisher Item ID: S2352-6440(23)00083-3 Publisher ID: 100835
                DOI: 10.1016/j.tcr.2023.100835
                PMC ID: 10189456
                SO-VID: b102cdd3-e3b4-44e6-8672-0515df345017
                Copyright © © 2023 The Authors. Published by Elsevier Ltd.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date accepted : 3 May 2023
                Categories
                Subject: Case Report

                Keywords: post-traumatic stroke,childhood stroke,head trauma,basal ganglia stroke
                Data availability:
                Keywords: post-traumatic stroke, childhood stroke, head trauma, basal ganglia stroke

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