Carolinas Research Day 2021

Clinical Case-Based Studies

06 New Onset Ischemic Cerebellar Infarction Secondary to Multi-Vessel Occlusion in Sixteen-Year-Old Male: A Case Report

Gretel Rodriguez, OMSIV, Hanna S. Sahhar, MD, FAAP, FACOP, Emily Medhus, OMSIV

Edward Via College of Osteopathic Medicine-Carolinas

Abstract: Ischemic strokes, although more common in adults, may also occur in neonates, infants and children. The rare occurrence of strokes in pediatrics makes it a difficult diagnosis because signs and symptoms are provider dependent. This diagnosis is further complicated by an inability to distinct it from what is considered normal child behavior during a clinical exam. For this reason, it is important to be extremely vigilant and perform thorough neurological examination when a stroke is suspected, especially in the least expected population of pediatrics. Initially, our patient presented with dizziness, confusion and agitation. Upon initial evaluation, a computerized tomography (CT) scan of the brain was unremarkable and the patient was admitted for observation to the pediatric intensive care unit secondary to altered mental status and possible overdose ingestion of his own medication of methylphenidate. The following morning after admission, the patient demonstrated signs and symptoms of a stroke, for which a CT

Angiogram of the brain and neck showed thrombi occluding the basilar artery and segments of the right vertebral artery. Mechanical thrombectomy was performed with successful recanalization. The patient later underwent a decompressive craniotomy to alleviate the increased intracranial pressure and prevent further neurological decline. The patient was able to recover and was discharged home to continue physical rehabilitation for mild neurological deficits. Extensive investigations of the etiology of the stroke including the hypercoagulable studies were unremarkable except for mildly decreased activity levels of protein C and protein S at 46% (normal range 70% -180%) and 63% (normal range 70% -150%) respectively. This case depicts a patient presentation of cerebellar infarction that is not consistent with initial physical examination findings or neuroimaging, further supporting the ambiguity of diagnosing stroke in children.

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