Pediatric Stroke due to Thoracic Outlet Syndrome Treated with Thrombolysis and Thrombectomy: A Case Report

Abstract

Thoracic outlet syndrome (TOS) is a condition that results from the compression of neurovascular structures as they exit the thorax. Arterial ischemic stroke can occur in TOS due to retrograde embolism from the subclavian artery. We describe a 15-year-old girl who presented with left hemiplegia after 2 weeks of right arm numbness and tingling. Imaging showed an acute ischemic stroke due to a right middle cerebral artery occlusion. She was treated with intravenous tissue plasminogen activator at 1.3 h and mechanical thrombectomy at 2.4 h with successful recanalization. Review of her neck computed tomography angiogram suggested a right subclavian artery aneurysm, and upper-extremity imaging also demonstrated distal thrombosis and fusion of right first and second ribs, which was consistent with thoracic outlet syndrome. Three days later, she underwent a right subclavian artery aneurysm repair, right brachial and ulnar artery thrombectomy, and first rib resection. Three months later, she demonstrated good neurologic recovery. TOS is an uncommon cause of stroke in children, which may be heralded by upper-extremity symptoms. Interventionalists should be aware of the possibility of vascular anomalies in children; however, this finding does not exclude the possibility of acute stroke intervention.

Treatment of thoracic outlet syndrome to alleviate chronic migraine headache

“…The other patient was in her 40s and developed an occipital stroke in the setting of a particularly bad migraine headache. Strokes have been reported in TOS, generally in the context of obstructed flow through a stenosed subclavian artery and stagnation of blood in an adjacent aneurysm 34, 35 . Neither of these situations applied to our patients but we note that one of these patients had complete resolution of her headaches after addressing her nTOS and vTOS.…”

“…The other patient was in her 40s and developed an occipital stroke in the setting of a particularly bad migraine headache. Strokes have been reported in TOS, generally in the context of obstructed flow through a stenosed subclavian artery and stagnation of blood in an adjacent aneurysm 34, 35 .…”