2023 Volume 32 Issue 6 Pages 385-390
The causes of pediatric ischemic stroke are diverse and causes of cerebrovascular stenosis include reversible cerebral vasoconstriction syndrome (RCVS), arterial dissection, and focal cerebral arteriopathy (FCA). In particular, reports of RCVS in children are rare, and the course and characteristics are not clear. We herein report a case of suspected RCVS in a child who initially developed obstruction of the intracranial internal carotid artery (ICA), followed by stenoses in the right middle cerebral artery (M1 and M2). A 15-year-old male suddenly developed severe headache and left hemiparesis while running. Magnetic resonance imaging (MRI) of the head showed narrowing of the right terminal ICA and a cerebral infarction in the right basal ganglia. Subsequently, the patient developed occlusion of the right terminal ICA and a new infarction in the right cerebral peduncle. Two months after onset, the recanalization of the right ICA and new stenoses of the right MCA (M1 and M2) were observed. The M1 stenosis improved after four months and the M2 stenosis after 3.5 years. RCVS was suspected in this case because of the reversible improvement of vascular stenosis. In pediatric ischemic stroke with cerebrovascular stenosis, it is necessary to consider RCVS, arterial dissection, and FCA as differential diagnoses. RCVS may develop new spasms at different sites over time, therefore a long period of follow up is required when RCVS is suspected.
