Ischemic stroke complicating pediatric cardiovascular disease.

BACKGROUND

After a year of unsuccessful treatment for hypertension, a young boy underwent a stenting procedure for aortic hypoplasia and awoke with hemiparesis and language deficits.

INVESTIGATIONS: Neuroimaging, echocardiography, craniocervical vascular imaging and prothrombotic testing.

DIAGNOSIS: Procedure-related acute arterial ischemic stroke and malignant cerebral edema with herniation.

MANAGEMENT: Anticoagulation with heparin, seizure prophylaxis and neuroprotective care, including external cooling for hyperthermia. Medical management of increased intracranial pressure and hemicraniectomy at 48 h for malignant cerebral edema. Treatment of deep vein thrombosis with inferior vena cava filter was also required. Long term treatments included extensive rehabilitation, aspirin, antiepileptics, antidyskinetics, antidepressants, antihypertensives and cosmetic skull reconstruction.