Ischemic Stroke In infant With Tetralogy of Fallot

Dian Ayu Hamama Pitra, Lydia Susanti

Abstract


Objectives: Although stroke is often viewed as occurring primarily in the elderly, it also strikes infants, children, young adults. Stroke in children are rare but increasingly important conditions due to the severity of their complications and diverse diagnostic differentials. It is not yet clearly understood and with multifactorial etiologies. When it comes to stroke, children are not just little adults. Stroke risk factors, symptoms, prevention efforts, and treatment are often different in children than in adults. Up to 80 % of children with ischemic stroke have cardiovascular disease. Case report: RS, An infant, aged two and half years old was admitted to DR. M. Djamil hospital Padang, with right hemiplegy and developed aphasia after activity. One year ago, he had history of cyanotic skin but neglected by his parents and never sought medical treatment. Physical findings on this patient are cyanosis and clubbing fingers. Cardiac auscultation revealed a pansystolic murmur grade III-IV best heard at the upper left sternal border. Chest radiograph showed a characteristic “bootshaped” heart, which is a reflection of Right Ventricular (RV) hypertrophy. The ECG showed right axis deviation. Brain CT Scan revealed a large hypodense lesion on the left cerebral hemisphere suggested as large brain infarction. Echocardiogram revealed tetralogy of fallot with a larged malaligned ventricular septal defect (VSD) with 60 % aortic override. Patient was managed conservatively. After two weeks of admission, patient was discharged with improvement.Conclusion : Ischemic stroke in this infant with tetralogy of fallot occurred via paradoxical embolism mechanism.


Keywords


Ischemic stroke, Tetralogy of Fallot, Large brain infarct, Paradoxical Embolism.

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References


Roach ES, Golomb MR, Adams R, Biller J, Daniels S, deVeber G, et al. Management of Stroke in Infants and Children: A Scientific Statement From A Special Writing Group of The American Heart Association Stroke Council and The Council on Cardiovascular Disease in the Young. Stroke. 2008;39:2264-2691

Rafay MF. Ischemic Stroke in Children-Overview Including an Asian Perspective. J Pak Med Assoc Vol.58, No.7, July 2008.

Filho EM, de Carvalho WB. Stroke in Children. J Pediatr (Rio J). 2009; 85(6):469-479

Ranzan J, Rotta NT. Ischemic Stroke in Children; A Study of The Associated Alterations. Arq Neuropsiquiatr 2004;62(3-A):618-625

Ballerini L, Gimigliano F, Ammirati A, Cifarelli A. Ischemic Stroke in Children-Role of Patent Foramen Ovale. European Pediatrics Review 2007.

Gottl UN, Gunther G, Kurnik K, Strater R, Kirkham F Arterial Ischemic Stroke in Neonates, Infants, and Children: An Overview of Underlying Conditions, Imaging Methods, and Treatment Modalitis. Seminars in Thrombosis and Hemostasis, volume 29, number 4, 2003.

Kirkham F, Sebire G, Steinlin M, Strater R. Arterial Ischemic Stroke in Children. Review of the Literature and Strategies for Future Stroke Studies. Thromb Haemost 2004;92:697-706

Mackay MT. Stroke in Children. Australian Family Physician 2011;36:11

Krishna CS, Reddy GK, Debta M, Panigrahi NK. Tetralogy of Fallot with Rheumatic Mitral Stenosis: A case report.

Cheng WW, Ko CH, Chan AKH. Pediatric stroke: case series. HKMJ 2002;8:216-20

Lin MS, Chang NC, Lee TS. New Advances in the Diagnosis and Management of Cardioembolic Stroke. Acta Cardiol Sin 2005;21:1_12

Greer DM, Homma S, Furie KL. Cardiac Diseases. In: Mohr JP et al.,eds. Stroke Pathophysiology, Diagnosis, and Management. 5th edition. 2011. Philadelphia : Elsevier Saunders. Pg 814-817.

Hirsch R, Streifler JY. Stroke in Congenital Heart Disease and Patent Foramen Ovale. IMAJ 2005;8:798-802

Barnes C, Newall F, Furmedge J, Mackay M, Monagle P. Arterial Ischemic Stroke in Children. J. Pediatr.Child Health (2004) 40, 384-387

Karl TR. Tetralogy of Fallot: A Surgical Perspective. Korean J Thorac Cardiovasc Surg 2012;45:213-224

Silversides CK, Kiess MK, Beauchesne L, Bradley T, Connelly M, Niwa K, et al. Canadian Cardiovascular Society 2009 Consensus Conference on The Management of Adults with Congenital Heart Disease: Outflow tract Obstruction, coarctation of the aorta, tetralogy of Fallot, Ebstein anomaly and Marfan’s Syndrome. Can J Cardiol 2010;26:3: 896-902

Jin KN, Chun EJ, Choi SI, , Ko SM, Han MK, Bae HJ, Park JH. Cardioembolic Origin in Patients with Embolic Stroke: Spectrum of Imaging Findings on Cardiac MDCT

Camm AJ. Stroke Prevention in Atrial Fibrillation-The Unmet Need and Mortality Burden.European Cardiology, 2011;7(3):187-195

Albers GW, et al. Antithrombotic Therapy in Atrial Fibrillation. Chest. 2001;119:194S-206S.

Golomb MR. Strokes in Neonates and Children: Overview. In: Biller J, 2nd ed. Stroke in Children and Young Adults. 2009. Philadelphia: Saunders Elsevier




DOI: https://doi.org/10.33854/heme.v1i1.221

DOI (PDF): https://doi.org/10.33854/heme.v1i1.221.g145

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