Acute basilar artery thrombosis in childhood: A therapeutic dilemma

Introduction: Acute basilar artery thrombosis (ABAT) in childhood is a very rare occasion and morbidity and mortality rates are high. Treatment options vary greatly, treatment guidelines are not evidence based.

Case report: We want to report a case from a 5-year old, who presented with a complete locked-in-syndrome in the emergency unit of a regional hospital. He was treated with systemic lysis for 30 hours, then was heparinized and after 2 month the treatment was switched to a salicylate therapy. After the acute phase he was admitted to a rehabilitation centre, where he had a multimodal programme. After 6 month he was dismissed as a householdwalker, ready to attend the first class of his local school together with his twin brother.

Discussion: There are no clear treatment guidelines for the ABAT in childhood, due to the fact that it is a very rare occasion and that there are no clinical trials. It is not possible to copy the treatment guidelines from adults and use them for children, therefore the options and the actual therapies that were done reported in several case reports vary greatly from doing nothing to surgical treatment.

Risk factors for paediatric stroke are multiple and it is not always clear which one is the main and which one is a co-factor, also considering the fact that sometimes no factor at all is found.

Rehabilitation including the reintegration after dismissal is an important part of the treatment. The children are usually young and it is necessary to find an adequate environment.

Conclusion: It is important to strengthen the fact that all cases with ABAT in childhood need to be registered in order to get a better idea of treatment options, which are based on valid statistical analysis.