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    Case of the Day
    Cerebellar Infarcts In A Child

    Modality: MRI Modality: MRI Modality: MRI Modality: MRI Modality: MRI Modality: MRI Modality: MRI Modality: MRI

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    Go to the top of the page ID: 20090426082652
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     Cerebellar Infarcts In A Child   
     Available images: There are MRI images available for this case. [ MRI ]   
     Author/s:

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

     
     Email Address:

    Viewable for logged on visitors (Log on)  

     
     Age:

    6 Years  

     
     Gender:

    Female  

     
     History:

    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.  

     
     Pathomorphology or Pathophysiology of this disease :

    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.  

     
     Radiological findings:


    MRI 1 <- view MRI 1

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

    MRI 2 <- view MRI 2

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

    MRI 3 <- view MRI 3

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

    MRI 4 <- view MRI 4

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

    MRI 5 <- view MRI 5

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

    MRI 6 <- view MRI 6

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

    MRI 7 <- view MRI 7

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

    MRI 8 <- view MRI 8

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

     

     
     Diagnosis confirmation:

    Expert's opinion  

     
     Which DD would be also possible with the radiological findings:

    Posterior fossa mass  

     
     Course / Prognosis / Frequency / Other :

    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  

     
     Comments of the author about the case:

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

     
     First description / History:

    N/A  

     
     Literature:

    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.  

     
     Region-Organ:

    Head-Brain and brain nerves  

     
     Most likely etiology:

    circulatory  

     
     Available images: There are MRI images available for this case. [ MRI ]   
    More cases from these authors: Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (8)     




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