Sanjeeb Kumar Sarma (Down Town Hospital/Guwahati/India)  

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6 Years  

Female  

A 6-year old girl with poor physical built presented with gait abnormality, vomiting and recurrent headache since last 15 days. The patient was slightly irritated at the time of presentation. However, there was no history of convulsion or altered sensorium.  

The most common site of infarction is the basal ganglia followed by thalamus. Cerebellar infarction is thought to be rare in children. It has been found that infarcts are most common in the posterior inferior cerebellar artery distribution, followed by the superior cerebellar artery and anterior inferior cerebellar artery distribution. Abnormal gait, vertigo, headache, nausea, and vomiting are the presenting symptoms. Causes of stroke in children are many, ranging from intra-cerebral vascular processes like moyamoya, hemoglobinopathies, coagulation disorders e.g. protein C and S deficiencies, leukemia, meningitis, septicaemia, metabolic diseases, iron deficiency anemia, drugs to autoimmune conditions. Trauma in the form of head / cervical injuries or child abuse is also a known cause.  

<- view MRI 1

MRI 1: Axial T2W Image showing a hyperintense geographic area in cerebellum in relation to left posterior inferior artery territory.

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MRI 2: Axial T2W Image showing another hyperintense geographic area similar to Fig1 in cerebellum in relation to right superior cerebellar artery territory.

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MRI 3: Axial T2W Image at a higher level showing similar findings as Fig2.

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MRI 4: Axial T1W Image at the same level as Fig1 showing hypointense geographic area in relation to left posterior inferior artery territory.

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MRI 5: Axial T1W Image showing hypointense area in relation to right superior cerebellar artery territory.

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MRI 6: Coronal T2W Image showing hyperintense area in cerebellum in relation to different arterial territory.

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MRI 7: Sagittal T1W Image showing wedge shaped hypointense area in relation to right superior cerebellar artery territory.

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MRI 8: Sagittal T1W Image showing hypointense area in relation to left posterior inferior artery territory.

Expert's opinion  

Posterior fossa mass  

Prognosis of cerebellar infarct is good. Full recovery is seen in 53% of patients with posterior inferior cerebellar artery infarcts, and 71% of patients with superior cerebellar artery infarcts  

The child shows dramatic clinical improvement following regular aspirin and oral iron supplement as she was anemic. Probably anemia was the underlying cause.  

N/A  

Caplan LR. Stroke: A Clinical Approach. 2nd ed. Massachusetts: Butterworth-Heinemann; 1993.

Hartfield DS, Lwry NJ, Keene DL et al.
Iron deficiency: a cause of stroke in infants and children.
Pediatr Neurol. 1997 Jan; 16(1): 50-3.

Anne G. Osborn. Diagnostic Neuroradiology by (Mosby)- chapter 11. Stroke.P 330-398.

Chatkupt S, Epstein LG, Rappaport R et al.
Cerebellar infarction in children.
Pediatr Neurol. 1987 Nov-Dec;3(6):363-6.  

Head-Brain and brain nerves  

circulatory