A case of symmetric retrograde thromboembolic cerebral infarction in an 8-year-old child due to arterial thoracic outlet syndrome

Strzelecka, Jolanta; Skadorwa, Tymon; Franckiewicz, Milena; Jóźwiak, Sergiusz

doi:10.1007/s00381-018-3911-x

Cited by 6 publications

(4 citation statements)

References 19 publications

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“…1). These factors differ significantly from those in adults [19][20][21][22]. In a large-scale study by Mackay et al, the most common were arteriopathies (53%), cardiac disorders (31%), and infections (24%) [23].…”

Section: Risk Factorsmentioning

confidence: 96%

Paediatric stroke — a review of current guidelines for diagnosis and treatment

Oborska

Urban

Wychowaniec

et al. 2018

Neurol Neurochir Pol.

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Stroke, increasingly recognised in children in recent years, is an important cause of long-term morbidity and disability. It can be classified by the stroke type as either arterial ischaemic stroke (AIS), haemorrhagic stroke (HS), or cerebral sinovenous thrombosis (CSVT). Furthermore, perinatal and childhood stroke can be distinguished. A wide range of conditions associated with paediatric stroke has been identified, which differ significantly from those in adults. A paediatric stroke can also present with a variety of symptoms and signs, both specific and non-specific. Because of the diversity of the underlying risk factors, limited awareness among the medical community, and therefore insufficient recognition of paediatric stroke symptoms, diagnosis can be difficult and is often delayed. This limits access to acute interventions. The goal of this paper was to examine the current guidelines for the diagnosis and treatment of paediatric stroke.

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Section: Risk Factorsmentioning

confidence: 96%

Paediatric stroke — a review of current guidelines for diagnosis and treatment

Oborska

Urban

Wychowaniec

et al. 2018

Neurol Neurochir Pol.

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“…Preexisting literature has shown that patients with TOS have developed thromboembolus that travelled retrograded from the subclavian artery to the head and caused stroke, 36,37,38,39,40,41,42 demonstrating the potential for retrograde flow from subclavian to carotid artery in TOS patients. We postulate that the compression imposed on the distal subclavian artery in TOS not only inhibits some blood from entering the brachial artery, but that the obstructed blood reverts toward the head, resulting in, to some extent, continuous TOS-induced cerebrovascular hyperperfusion (CVH).…”

Section: Tos' Effect On Haemodynamics and Its Implicationsmentioning

confidence: 99%

Does thoracic outlet syndrome cause cerebrovascular hyperperfusion? Diagnostic markers for occult craniovascular congestion

Larsen

Galluccio

Chand³

2020

APIC

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Thoracic outlet syndrome (TOS) is known to be associated with diffuse craniological comorbidities (CCM), such as occipital headaches, migraines, vestibular dysfunction, tinnitus and fatigue. Conventionally, these problems have been suggested to be a manifestation of positional vertebrobasilar insufficiency. Angiography tends to be normal in TOS sufferers, however, and doppler ultrasonography of the vertebral artery fails to demonstrate severe flow reduction. TOS is attributed to the brachial plexus and subclavian artery being compressed in the interscalene triangle, costoclavicular or subpectoral passages. The vertebral and carotid arteries arise from subclavian artery proximal to the sites of obstruction in TOS. Numerous reports of resolved CCM post-scalenectomy and first-rib resection, despite lacking vertebral artery impairment, have been documented. TOS CCM, moreover, share many of the symptoms seen in systemic and intracranial hypertension. Reports of subclavian thromboembolus migrating to the head have been documented in incidences of TOS, showing the potential for flow retrogradation. We postulate that the blood prevented from entering the brachium due to distal subclavian compression, retrogrades to the brain via the carotid and vertebral arteries, resulting in craniovascular hyperperfusion and congestion. Abbreviations: Thoracic outlet syndrome: TOS, Vertebral artery: VA, Vertebrobasilar insufficiency: VBI, Cerebrovascular hyperperfusion: CVH, Blood-brain barrier: BBB, Myalgic encephalomyelitis: ME, “Time of flight”: TOF, Citation: Larsen K, Galluccio FC, Chand SK. Does thoracic outlet syndrome cause cerebrovascular hyperperfusion? Diagnostic markers for occult craniovascular congestion. Anaesth pain intensive care 2020;24(1)___ Received – 30 November 2019; Reviewed – 2, 6 February 2019; Accepted – 27 February 2019;

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“…Arterial TOS is frequently associated with a cervical rib, which occurs in 1% of the population and is rarely symptomatic. Acute ischemic stroke (AIS) has been reported in more than 30 individuals with arterial TOS [ 7 ] and is a rare cause of stroke in children [ 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. We present a 15-year-old girl with AIS due to TOS, complicated by subclavian artery thrombosis and subsequent embolism, whose stroke was treated with intravenous thrombolysis and mechanical thrombectomy.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Stroke due to Thoracic Outlet Syndrome Treated with Thrombolysis and Thrombectomy: A Case Report

et al. 2022

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Thoracic outlet syndrome (TOS) is a condition that results from the compression of neurovascular structures as they exit the thorax. Arterial ischemic stroke can occur in TOS due to retrograde embolism from the subclavian artery. We describe a 15-year-old girl who presented with left hemiplegia after 2 weeks of right arm numbness and tingling. Imaging showed an acute ischemic stroke due to a right middle cerebral artery occlusion. She was treated with intravenous tissue plasminogen activator at 1.3 h and mechanical thrombectomy at 2.4 h with successful recanalization. Review of her neck computed tomography angiogram suggested a right subclavian artery aneurysm, and upper-extremity imaging also demonstrated distal thrombosis and fusion of right first and second ribs, which was consistent with thoracic outlet syndrome. Three days later, she underwent a right subclavian artery aneurysm repair, right brachial and ulnar artery thrombectomy, and first rib resection. Three months later, she demonstrated good neurologic recovery. TOS is an uncommon cause of stroke in children, which may be heralded by upper-extremity symptoms. Interventionalists should be aware of the possibility of vascular anomalies in children; however, this finding does not exclude the possibility of acute stroke intervention.

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A case of symmetric retrograde thromboembolic cerebral infarction in an 8-year-old child due to arterial thoracic outlet syndrome

Cited by 6 publications

References 19 publications

Paediatric stroke — a review of current guidelines for diagnosis and treatment

Paediatric stroke — a review of current guidelines for diagnosis and treatment

Does thoracic outlet syndrome cause cerebrovascular hyperperfusion? Diagnostic markers for occult craniovascular congestion

Pediatric Stroke due to Thoracic Outlet Syndrome Treated with Thrombolysis and Thrombectomy: A Case Report

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