Childhood arterial ischemic stroke due to mineralizing angiopathy: an 18‐year single‐center experience

Abstract

Mineralizing angiopathy is a unique, age‐specific stroke syndrome characterized by basal ganglia infarction and lenticulostriate calcification after minor head injury in early childhood. There is limited understanding of the pathophysiology, course, and clinical outcome of this syndrome. We describe the clinical and radiographical phenotype of a single‐center, consecutively enrolled cohort of children with mineralizing angiopathy from January 2002 to January 2020 and provide a comparative analysis to previously published literature. Fourteen children were identified. Previously unreported findings include: stroke onset in eight children older than 18 months; presence of basal ganglia hemorrhage in four; multifocal basal ganglia infarcts in three; presence of additional non‐basal ganglia calcifications in three; and presence of thrombophilia in one. Seven children had moderate‐to‐severe neurological deficits. There was no symptomatic stroke recurrence (mean follow‐up 3y 7mo, SD 1y 7mo). Our expanded phenotype highlights distinct characteristics of mineralizing angiopathy in children and has the potential to inform future research. Children with mineralizing angiopathy are often misdiagnosed as having a limb fracture despite normal x‐rays. A magnetic resonance imaging‐only approach may miss this entity. Non‐contrast computed tomography, in addition to MRI is recommended to identify calcifications in idiopathic arterial ischemic stroke. Most children have moderate‐to‐severe neurological sequela.

Pediatric Stroke—Are We Asking the Right Questions?

“…A review of initial and follow-up imaging showed subtle hyperdensities in the bilateral basal ganglia, suggesting possible mineralizing angiopathy of the lenticulostriate arteries, which is associated with basal ganglia ischemic stroke and hemorrhage after minor trauma, typically in younger children. 50 reported in cardioembolic stroke in adults and in children. [18][19][20] The safe timing of starting or resuming anticoagulation is a frequent question in children after cardioembolic stroke, particularly those requiring procedures, based on the increased incidence of hemorrhagic transformation reported in adults on anticoagulation.…”

“…A review of initial and follow-up imaging showed subtle hyperdensities in the bilateral basal ganglia, suggesting possible mineralizing angiopathy of the lenticulostriate arteries, which is associated with basal ganglia ischemic stroke and hemorrhage after minor trauma, typically in younger children. 50…”