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G402(P) The role of thrombolysis in paediatrics
  1. A Ponnampalam,
  2. M Prasad
  1. Department of Paediatrics, Nottingham University Hospital, Nottingham, UK

Abstract

Objective The incidence of stroke in children is approximately 5/ 100 000 children/year in the United Kingdom. We report a case of a right sided middle cerebral artery stroke in a 15 year old female patient who successfully underwent thrombolysis.

Methods She presented to a district general hospital (DGH) with a two hour history of right sided headache, dizziness, numbness and weakness in her left arm. There was also a history of right sided facial weakness and general clumsiness. She was previously healthy with no significant past medical history and no family history of note. She was however on oral contraceptive pill for heavy periods.

Results She underwent urgent MRI imaging which was consistent with right sided middle artery cerebral infarct. She was thrombolysed by the adult stroke team with Alteplase within three hours after initial presentation and transferred to tertiary care for consideration of embolectomy. The thrombus however had resolved on the repeat MRI with MRA at the tertiary centre on the same evening. Her symptoms improved rapidly within 24 hours with only some residual altered sensation on her dorsal hand and minimal reduction of power (4+/5) in the left wrist. She was discharged home on Aspirin 75 mg once daily and with the advise to stop the oral contraceptive pill. On follow up, her symptoms were fully resolved with no obvious other risk factor identified.

Conclusions Stroke in childhood remains a neglected topic despite it being in the top ten causes of childhood death. The use of thrombolytic agent in children continues to be an area of discussion with no RCT completed to support hyper acute thrombolysis. This case highlights a positive outcome of adult approach in childhood. Every single patient therefore needs careful consideration of his or her likely risk factors and discussion with a specialist neurologist for the appropriate management.

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