Pediatric Ischemic Stroke Presenting with Altered Consciousness and Brainstem Signs

Abstract

While ischemic stroke is rare in children, with an incidence rate of 1/3500 live births in newborns and 1–2 per 100,000 annually during childhood—peaking during the perinatal period, under the age of 5, and in adolescence—it ranks among the top 10 causes of death. It poses significant diagnostic and treatment challenges because of its multiple causes and often subtle, variable symptoms. The variability in symptoms based on age can delay diagnosis and worsen outcomes. Early management should focus on prompt recognition, a standardized approach (ABCDE), and an early neurological examination with neuroimaging—preferably magnetic resonance imaging (MRI). This case involves a healthy school-aged child who suddenly developed neurological symptoms at home and was later diagnosed with a brainstem stroke caused by thrombosis of the right posterior cerebral artery (PCA). Although the computed tomography (CT) scan appeared normal, the MRI confirmed the diagnosis. Laboratory tests showed elevated Lipoprotein (Lp) levels, a recently recognized independent risk factor for pediatric arterial ischemic stroke. Overall, this case underscores the importance of early detection, advanced neuroimaging, and thorough etiologic evaluation, including thrombophilia screening, in the diagnosis and management of pediatric stroke.