Ischemic stroke in Kawasaki disease

Abstract

Pediatric stroke is considered to be rare. Stroke resulting from cerebral vasculitis is also uncommon in young children. With the increasing prevalence of Kawasaki disease (KD) diagnosis, this acquired vasculitis has been reported with various clinical presentations including neurological symptoms. Herein we describe the case of a KD patient presenting with stroke. A 15-month-old boy was referred due to stroke that occurred on the fifth day of febrile illness. He was initially admitted to another hospital due to fever and diarrhea. He was discharged and re-admitted 2 days afterward due to left hemiplegia. During the 10 days of the second hospitalization, he had a presumptive diagnosis of encephalomeningitis. Upon referral to the present hospital, he was found to have right middle cerebral artery branch stenosis and fusiform aneurysms of the coronary arteries. Retrospectively, the patient had the full clinical criteria for KD diagnosis. Therefore, stroke could be considered as one of the uncommon clinical manifestations of KD.

Kawasaki Disease Complicated by Late-Onset Fatal Cerebral Infarction: A Case Report and Literature Review

“…The possibility of moyamoya disease and syndrome was also excluded by MRA. Second, despite its rarity, KDassociated cerebral infarction has been reported in several cases (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). In most cases, cerebral infarction always occurred in the middle cerebral artery territory because KD predominantly affects medium-sized arteries (14,15,17,21,(23)(24)(25)(26)(27).…”

“…Second, despite its rarity, KD-associated cerebral infarction has been reported in several cases ( 14 – 26 ). In most cases, cerebral infarction always occurred in the middle cerebral artery territory because KD predominantly affects medium-sized arteries ( 14 , 15 , 17 , 21 , 23 – 27 ). In our patient, the initial brain CT showed a well-defined hypodense lesion involving gray and white matter in the right basal ganglion, suggestive of right middle cerebral artery infarction.…”

“…Autopsies of children with KD have revealed signs of cerebral vasculitis affecting small- and medium-sized vessels, with features of endarteritis, periarteritis, and perivascular cuffing ( 35 ). Occlusion/stenosis and/or aneurysm of the cerebral arteries were observed in patients with KD complicated by cerebral infarction ( 15 – 17 , 21 , 25 ). Additionally, a very specific radiological sign that strengthened the vasculitis hypothesis was diffuse microhemorrhages (T2 * -weighted sequence) associated with white matter injury on brain magnetic resonance imaging (MRI) in a 4-year-old girl who presented with unusual, rapidly catastrophic KD in which tetraplegia developed 15 days after KD onset ( 18 ).…”

“…The most frequently described neurological manifestations are headache, convulsions, somnolence, extreme irritability, signs of meningeal irritation, bulging fontanelles, hemiparesis, and facial palsy (12,13). Cerebral infarction has been described as a rare complication of KD and always occurs during acute or subacute illness (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Currently, only one case of late-onset cerebral infarction has been reported, occurring 4 months after KD onset (16).…”

Sodium Toxicity in the Nutritional Epidemiology and Nutritional Immunology of COVID-19

“…In addition, pediatric Kawasaki-like symptoms associated with COVID-19 have been reported, known as multi-system inflammatory syndrome in children (MIS-C) [ 95 ]. As in COVID-19, MIS-C and Kawasaki-like symptoms have also been associated with hypertension [ 96 ], stroke [ 97 ], acute heart failure [ 98 ], and acute kidney injury [ 99 ], transitively linking sodium toxicity to pediatric disease pathophysiology. Although other dietary, environmental, and lifestyle factors are relevant to the pathophysiology of COVID-19, numerous transitive links with COVID-19 suggest that sodium toxicity may be among the leading factors potentially contributing to the disease.…”