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12TH INTERCONTINENTAL EMERGENCY MEDICINE CONGRESS &12TH INTERNATIONAL CRITICAL CARE AND EMERGENCY MEDICINE CONGRESS, Antalya, Turkey, 17 - 20 April 2025, pp.87-88, (Full Text)
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A Rare Cause of Childhood Stroke: Minor Head Trauma
Mehmed ULU1, Abdil Coskun2
1Adiyaman Research and Training Hospital
2Kutahya Health Sciences University Medical Faculty Emergency Department
Introduction
Head trauma is an important cause of mortality and morbidity in pediatric patients over 1 years of age. Falls from the same level and falls from height are the most common causes of head trauma. The majority of these patients who present to the emergency department are consistent with mild head trauma (1). Although cases consistent with severe head trauma are fewer in number, the pathologies leading to mortality and morbidity are more frequently observed in this patient group. Subdural, epidural, subarachnoid, and intracerebral hemorrhages, cerebral contusion and edema, and diffuse axonal injury are among the major trauma-related pathologies observed in these patients (1,2). Ischemic stroke following mild head trauma is a rare post-traumatic pathology in the pediatric age group. Although the exact cause is unknown, it is thought to be related to vasospasm or thrombosis of the lenticulostriate arteries following trauma. It is usually observed in the basal ganglia region (2,3,4). This case report presents a 3-year-old patient who was admitted to the emergency department following mild head trauma and was subsequently diagnosed with ischemic stroke secondary to trauma.
Case
A 3-year-old girl was admitted to our emergency department (ED) after falling from a seat approximately 25 inches high, 12 hours earlier. She has no known history of chronic disease and presented with malaise and impaired consciousness. The patient fell on the left parietal region and a small hematoma was identified in that area. Her parents reported that she had initially been evaluated at a local ED after the fall, where her head computed tomography (CT) and laboratory results were normal, and she was discharged. However, due to her persistent symptoms, they brought her to our ED. Her vital signs were stable and she had isolated head trauma, other systemic examination was normal. On admission, she was lethargic, uncooperative, and had a Glasgow Coma Scale (GCS) score of 11. Neurological examination revealed weakness in her left arm and leg, with muscle strength graded at 4/5. Laboratory tests showed hemoglobin at 10.5, glucose at 69, pH at 7.28, and bicarbonate at 12, while other laboratory results were within normal limits. Both head and spinal CT scans were normal. The patient was consulted with a neurosurgeon. The neurosurgeron recommended a diffusion MRI, and the performed diffusion MRI revealed diffusion restriction compatible with acute ischemia in the right lentiform nucleus and the posterior part of the body of the caudate nucleus (Figure-1).
The patient was consulted with pediatric neurology based on imaging findings and was admitted to the pediatric intensive care unit with a preliminary diagnosis of ischemic cerebrovascular event. The patient was also evaluated by pediatric hematology and cardiology, and advanced investigations for the etiology of ischemic stroke were inconclusive. The patient was diagnosed with ischemic stroke secondary to minor head trauma. After 7 days in intensive care and 1 day of pediatric ward follow-up, the patient was discharged. According to the patient’s relatives, one week after discharge, the weakness in the left upper and lower extremities gradually improved and returned to normal without any sequelae. Conclussion In pediatric patients, head trauma commonly causes intracerebral hemorrhage; however, in rare cases, it can also lead to ischemic stroke. Clinicians should be aware of this rare complication, especially when neurological deficits persist despite normal initial imaging.
Keywords: Minor head trauma, childhood stroke, pediatric head trauma