Post-traumatic massive middle cerebral artery infarction in a child: A Case Report

Background: Ischemic Stroke is extremely rare in children and usually occurs due to underlying medical conditions, which include congenital heart disease and hematological, metabolic, or immunological disorders. Traumatic causes are rare, with few cases reported in the literature. Case report: We report a case of a previously healthy two-year-old male toddler who presented to our facility with loss of consciousness following a motor vehicular accident, from which he partially improved about 3 minutes later with no other systemic injuries. On examination, he was irritable, with a Glasgow coma scale score (GCS) of 14/15 (E4V4M6) and no neurological deficit. A day after admission, he developed a progressive right hemiparesis with deterioration in his conscious level. GCS dropped to 8/15(E2V2M4) and transferred into the intensive care unit (ICU) where he was intubated and mechanically ventilated. Other nonoperative measures for the management of traumatic brain injury which included, nursing in 30 degrees head up, intravenous fluid, analgesic, and close monitoring of vital signs were instituted. Brain computed tomography done following neurologic deterioration revealed features of massive left middle cerebral artery infarction. All investigations done to rule out co-morbidities were normal. The patient died four days after admission. Conclusion: Post-traumatic Middle Cerebral Artery infarction among children is very rare and usually a diagnosis of exclusion. Initial computed tomography of the brain is usually unremarkable. However, features of infarction appear in subsequent imaging done due to neurologic deterioration. As such diagnosis is delayed leading to increased morbidity and possible mortality