Posttraumatic Bilateral Basal Ganglia Infarct in Pediatric A
The present case has been reported in the Indian Journal of Neurosurgery. An 18-month-old boy presented to the emergency department following head injury. He fell from a height of approximately 50 cm onto a thinly carpeted floor. The child did not lose consciousness and had no history of seizure. He developed a right hemiparesis after 8 hours. Glasgow coma scale (GCS) score at the time of presentation was 14, and the child was isochoric with isocyclic pupils, but there was a right brachiocrural hemiparesis with muscle strength of 2/5.

A computed tomographic (CT) scan of the head was done, which did not show any abnormalities. A hematologic workup was performed to exclude the possibility of a genetic predisposition to thrombosis that includes coagulation time, bleeding time, prothrombin time, and D-dimer levels. These investigations were normal. Antinuclear antibody and anti-Ds DNA were negative. We also evaluated thyroid hormone assays that were normal.

A magnetic resonance imaging (MRI) of the brain was performed, and it documented the presence of a ischemic lesion of bilateral caudate nucleus and on left involving internal capsule. Magnetic resonance angiography (MRA) was normal. We could not carry out genetic testing due to financial restrictions with family.

Acetyl salicylic acid was started at a dose of 50 mg/day for a week. The child was discharged with improvement in motor power with strength of 3/5 in both the upper and the lower limbs, and is under regular follow-up. At the last follow-up 1 month prior to this manuscript being written, the motor power was the same, but the child was able to use the upper limb for holding and playing with toys and could walk with support with slight limping. A review of the literature was conducted using PubMed. We searched the terms “head trauma,” “child,” and “basal ganglia ischemia.” We selected manuscripts reporting young patients aged 0 to 18 months presenting with lenticulocapsular ischemia due to head injury. Most of the cases have unilateral lesion, and only one case has bilateral lesion. This makes our case a rare entity as the lesions are mirror image infarct.
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Dr. C●●●●●●●●R M●●●●●A MD D●●, M●●●●●D N●●●●●●l M●d C and 3 others like this
Dr. C●●●●●●●●R M●●●●●A MD D●●, M●●●●●D N●●●●●●l M●d C
Dr. C●●●●●●●●R M●●●●●A MD D●●, M●●●●●D N●●●●●●l M●d C Neonatology
Mar 29, 2019Like