Acidente vascular pediátrico: lembrar para diagnosticar. Casos clínicos e linhas de orientação

Pediatric Stroke: Diagnostic Reminders, Case Studies and Guidelines

Abstract

Objective: Pediatric stroke affects an estimated 2 to 13/100 000 children each year, with diffi culties in diagnosis, treatment
and etiological investigation. This paper describes two cases of pediatric stroke with different etiologies (ischemic and
hemorrhagic) that illustrate these diffi culties. Data source and synthesis: The fi rst case study presents a healthy thirteen
year old Caucasian girl with sudden-onset aphasia where the MRI showed an ischemic stroke near the cortical branch of
the left middle cerebral artery. The investigation did not allow a conclusive etiological diagnosis of stroke. Her progress was favorable, with full recovery from the neurological defi cits, taking acetylsalicylic acid (AAS). The second case study presents
a sixteen year old girl with right parietal headache, vomiting and acute left hemiparesis. The computed tomographic
(CT) scan showed acute intraparenchymal hematoma in the right front insular temporal subcortical area, with cerebral
angiography revealing arteriovenous malformation (AVM) in the right insular region and several aneurysmal formations.
Treatment included embolization and subsequent decompressive craniotomy, with neurological sequelae still persisting.
Diagnosis is hampered by the non-specifi c symptomology that is inherent to complaints presented by adolescents.
Conclusion: As the pediatric age bracket has expanded, it is important to raise awareness among healthcare practitioners
in order to recognize these vascular events, allowing early targeted intervention and minimizing the sequelae. A theoretical
review of pediatric stroke is presented, suggesting guidelines for diagnosis, approaches and treatment.