Repetitive navigated transcranial magnetic stimulation to facilitate motor rehabilitation in acute pediatric hemorrhagic stroke - illustrative case.

BACKGROUND

Hemorrhage from arteriovenous malformations (AVMs) represents the most frequent cause of pediatric hemorrhagic stroke. However, outcomes often bear permanent extensive neurological impairments.

OBSERVATIONS: An eleven-year-old male presented to the emergency department following a sudden onset of left-sided hemiparesis and continued loss of consciousness after an epileptic seizure. Imaging revealed a large hemorrhagic stroke of the right frontal lobe resulting from bleeding of an arteriovenous malformation. After microsurgical resection, low-frequency repetitive navigated transcranial magnetic stimulation (nrTMS) therapy targeting the motor hotspot of the unaffected hemisphere was administered. At the 4-month follow-up visit, the patient recovered motor function, with persisting minor deficits in leg mobility and a predominantly distant arm paresis.

LESSONS: Utilizing nrTMS in pediatric patients effectively assessed motor function and in addition potentially contributed to early-stage motor rehabilitation. This method marks a potential advancement in acute pediatric stroke management.