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An 8 year old boy complained of headache and vomiting one morning and became drowsy in the afternoon. On the following day, diplopia and consciousness disturbance progressed. On admission to hospital, he was comatose and neurological examination revealed right hemianopsia and right ptosis. Other cranial nerve involvement was not recognised. MRI revealed T2 high intensity lesions in bilateral occipital calcarine and the left cerebellar hemisphere (fig 1). Routine laboratory examination including coagulation system, lactate, pyruvate, serum amino acid analysis, and cerebrospinal fluid analysis showed no abnormal findings. Cardiac echosonography and electrocardiography revealed no abnormal findings. Cerebral angiography revealed a basilar artery occlusion (fig 2), but no dissection of carotid arteries. Subsequently, fibrinolytic therapy was performed using urokinase; recanalisation was achieved and his consciousness level improved markedly. On the 26th day after admission he was discharged without any sequelae.
Basilar artery infarction is extremely rare in children.1,2 Although the causes of basilar artery infarction include trauma, sepsis, endocarditis, arthritis, oral contraceptive use, hypercoagulable state, and basilar artery dissection, no apparent cause was determined in the present case, or in many other cases. Fortunately the patient recovered completely. We should be vigilant for this condition if we see a child with acute consciousness disturbance since early intervention can prevent neurological sequelae.
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