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Neuropediatrics 2018; 49(04): 262-268
DOI: 10.1055/s-0038-1649501
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Infantile Basal Ganglia Stroke after Mild Head Trauma Associated with Mineralizing Angiopathy of Lenticulostriate Arteries: An Under Recognized Entity

Sandra P. Toelle
1   Department of Pediatric Neurology, University Children's Hospital, Zürich, Switzerland
,
Tamara Avetisyan
2   Department of Pediatric Neurology, Yerevan State Medical University After Mkhitar Heratsi, “Muratsan” University Outpatient Clinic, Yerevan, Armenia
,
Nune Kuyumjyan
3   Department of Pediatric Neurology, “Sourb Astvatsamayr” Medical Center, Yerevan, Armenia
,
Biayna Sukhudyan
4   Department of Pediatric Neurology, Arabkir Medical Center, Yerevan, Armenia
,
Eugen Boltshauser   *
1   Department of Pediatric Neurology, University Children's Hospital, Zürich, Switzerland
,
Annette Hackenberg   *
1   Department of Pediatric Neurology, University Children's Hospital, Zürich, Switzerland
› Author Affiliations Funding This work was not supported by grants.
Further Information

Publication History

29 January 2018

25 March 2018

Publication Date:
23 May 2018 (online)

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Abstract

Basal ganglia infarction in young children, mostly after mild head trauma, has been repeatedly reported. The pathogenesis and the risk factors are not fully understood. Lenticulostriate vasculopathy, usually referred to as basal ganglia calcification, is discussed as one of them. We describe five young (7–13 months old on presentation) male children who suffered from hemiparesis due to ischemic stroke of the basal ganglia, four of them after minor head trauma. All of them had calcification in the basal ganglia visible on computed tomography or cranial ultrasound but not on magnetic resonance imaging. Follow-up care was remarkable for recurrent infarction in three patients. One patient had a second symptomatic stroke on the contralateral side, and two patients showed new asymptomatic infarctions in the contralateral basal ganglia on imaging. In view of the scant literature, this clinic-radiologic entity seems under recognized. We review the published cases and hypothesize that male sex and iron deficiency anemia are risk factors for basal ganglia stroke after minor trauma in the context of basal ganglia calcification in infants. We suggest to perform appropriate targeted neuroimaging in case of infantile basal ganglia stroke, and to consider prophylactic medical treatment, although its value in this context is not proven.

Keywords

basal ganglia - head injury - stroke - mineralizing angiopathy - lenticulostriate arteries - iron deficiency anemia

* These authors contributed equally.