Mineralizing angiopathy of lenticulostriate arteries with infantile basal ganglia infarct following minor head trauma: A case series

Abstract

Acute arterial ischemic stroke after minor head trauma has been reported in the past, mostly in infants. Most of these affected children had basal ganglia infarct on imaging. Investigations for other etiologies of stroke were noncontributory in most of the cases. Thin-slice computed tomography scan may show mineralizing angiopathy of lenticulostriate arteries. We report a clinical series of four infants who presented with the classical features of this distinct clinico-radiological entity. Clinical characteristics and risk factors at the time of stroke were described in detail. The long-term outcome on standard antiplatelet therapy is reported. None of the children had stroke recurrence during follow-up. The current literature on this clinico-radiological syndrome is reviewed in detail. In the typical cases, extensive etiological workup may not be warranted.

Childhood ischaemic stroke in the basal ganglia can lead to fine motor and anxiety disorders: a retrospective analysis and follow-up of 109 cases

“…However, some studies have found that basal ganglia calcification is actually the manifestation of mineralizing angiopathy of lenticulostriate arteries [ 4 ]. In this study, 21/109 (18.3%) children had bilateral basal ganglia calcification, and the incidence was almost consistent with previous studies [ 13 , 16 ]. All patients underwent blood and urine metabolic screening to ensure that basal ganglia calcification caused by genetic metabolic diseases was excluded.…”

“…In addition, the development of sphenoid bone in children is now complete; it cannot completely cover the temporal lobe, which makes the subarachnoid space relatively wide, consequently making the brain tissue and skull base more likely to undergo large horizontal displacement upon an acceleration or deceleration injury so that the lenticular artery is damaged [ 9 ]. A study reported that a child had an abnormal lenticular artery at the age of 1 month, and several months later, an ischaemic stroke was observed after mild trauma; at the same time, lenticulostriate artery mineralization was demonstrated [ 13 ]. Ivanov et al reported trauma-associated ischaemic stroke in an 8-month-old infant with pre-existing lenticulostriate vasculopathy [ 4 ].…”

Basal Ganglia Stroke after Mild Traumatic Brain Injury in Mineralizing Lenticulostriate Vasculopathy

“…[1][2][3]7 Hemiparesis is the most common symptom in this condition, followed by epileptic seizures. [1][2][3][7][8][9] Although this was not the case in this patient, a significant percentage of children with transient hemidystonia on the affected side has been reported. 1,7,9 At first, calcifications are asymptomatic, generally bilateral, multiple, and nonprogressive, which tend to disappear or decrease with age.…”

“…[1][2][3][7][8][9] Although this was not the case in this patient, a significant percentage of children with transient hemidystonia on the affected side has been reported. 1,7,9 At first, calcifications are asymptomatic, generally bilateral, multiple, and nonprogressive, which tend to disappear or decrease with age. 1,2 These calcifications typically appear on the CT scan as linear hyperdense lesions that run vertically through the lentiform nucleus's inferior sector, mimicking the lenticulostriate arteries' anatomy.…”

“…1,2 These calcifications typically appear on the CT scan as linear hyperdense lesions that run vertically through the lentiform nucleus's inferior sector, mimicking the lenticulostriate arteries' anatomy. 2,7,9 Magnetic resonance imaging (MRI) allows identifying ischemic lesions at the level of the BG and the internal capsule, revealing the compromise of the vascular territory of the lenticulostriate arteries. 1,3 Given the topography of the ischemic lesion and the history of encephalocranial trauma (ECT), the presence of arterial dissection was initially suspected.…”