Infantile Basal Ganglia Stroke after Mild Head Trauma Associated with Mineralizing Angiopathy of Lenticulostriate Arteries: An Under Recognized Entity

Abstract

Basal ganglia infarction in young children, mostly after mild head trauma, has been repeatedly reported. The pathogenesis and the risk factors are not fully understood. Lenticulostriate vasculopathy, usually referred to as basal ganglia calcification, is discussed as one of them. We describe five young (7-13 months old on presentation) male children who suffered from hemiparesis due to ischemic stroke of the basal ganglia, four of them after minor head trauma. All of them had calcification in the basal ganglia visible on computed tomography or cranial ultrasound but not on magnetic resonance imaging. Follow-up care was remarkable for recurrent infarction in three patients. One patient had a second symptomatic stroke on the contralateral side, and two patients showed new asymptomatic infarctions in the contralateral basal ganglia on imaging. In view of the scant literature, this clinic-radiologic entity seems under recognized. We review the published cases and hypothesize that male sex and iron deficiency anemia are risk factors for basal ganglia stroke after minor trauma in the context of basal ganglia calcification in infants. We suggest to perform appropriate targeted neuroimaging in case of infantile basal ganglia stroke, and to consider prophylactic medical treatment, although its value in this context is not proven.

Childhood arterial ischemic stroke due to mineralizing angiopathy: an 18‐year single‐center experience

“…None had a recurrent symptomatic stroke. Multifocal AIS at time of initial presentation and symptomatic recurrence has been reported 3,6 . Most AIS recurrence in the literature was after additional minor head trauma, and occurred up to 6 years regardless of treatment 6 .…”

“…Multifocal AIS at time of initial presentation and symptomatic recurrence has been reported. 3,6 Most AIS recurrence in the literature was after additional minor head trauma, and occurred up to 6 years regardless of treatment. 6 Prevention of such trauma in toddlers is difficult and evidence-based treatment guidelines are currently lacking.…”