Abstract
Background
Ischemic stroke is relatively rare in children, leading to a low level of suspicion
and delayed diagnosis, particularly in cases of posterior circulation occlusion when
symptoms are less indicative. Occlusion of the artery of Percheron (AOP) results in
nonspecific neurologic symptoms, including drowsiness, aphasia or dysarthria, ophthalmoplegia,
ataxia, and dysmetria. Previous reports, mainly in adults, described late diagnosis
and severe residual disability.
Case Report
We report a case of a 16-year-old male who presented to the pediatric emergency department
with altered mental status. There was no history of trauma or intoxication. The main
symptoms included confusion, slurred speech, and multiple falls starting 1 h before
arrival to the emergency department. No motor deficits or other focal signs were noticed.
The patient's consciousness gradually decreased followed by apneic events. Routine
laboratory tests, urinary toxic screen, and a computed tomography scan of the head
were normal. A magnetic resonance imaging scan of the brain revealed bilateral restrictive
changes in the thalamus. A diagnosis of AOP occlusion was made, and the patient was
treated with tissue plasminogen activator (6 h after symptom onset). He was extubated
on day 4 and discharged on the day 10 of admission without any neuropsychological
deficit.
Why Should an Emergency Physician Be Aware of This?
Posterior circulation stroke in the pediatric population is a diagnostic challenge
that often results in suboptimal treatment and unfavorable outcomes. Prompt imaging
studies in children with nonspecific altered mental status enable timely diagnosis
and thrombolytic treatment that may substantially improve the outcome.
Keywords
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Article info
Publication history
Published online: May 04, 2022
Accepted:
April 23,
2022
Received in revised form:
April 17,
2022
Received:
March 8,
2022
Footnotes
Reprints are not available from the authors.
Identification
Copyright
© 2022 Published by Elsevier Inc.