Subject: Re: Acute CVA in a 2 year old
Forum: The Neurology and Neurosurgery Forum
Topic Area: Neurology - General
Posted by CCF MD mdf on September 24, 1998 at 23:02:19:
In Reply to: Acute CVA in a 2 year old posted by Mark on September 24, 1998 at 20:22:21:

Assessment:
1. Acute CVA in a 2 year old on 9/18/98
2. By MRA, allegedly there is an absent left anterior cerebral artery, absent bilateral posterior cerebral arteries and a narrowed proximal left middle cerebral artery.
3. Rule our hyperviscosity, status post enterovirus etiology.

Observations:
2 year old female,vitals are stable. Pupils were equal, round and reactive to light. Spontaneously moving all four extremities, however right arm less active then left. Integumentary is pink, warm and dry. No facial droop.

Thoughts have been as serious as "Moyamoya" (been told it is not) Possible AVM (Arteriovenous Malformation)?

Any help, thoughts or suggestions greatly appreciated.

=

I'm not sure what to advise you here. It sounds serious, according to the MRA. The problem is, can you believe the MRA. I think the doctors should think seriously about doing an intra-arterial dye subtraction angiogram which is more invasive but more definitive. It is possible that the MRA just doesn't show vessels that are working OK. Or, if as it suggests, there are multiple sites of vascular occlusion, then the diagnostic possibilities are probably different than if there were just one blocked artery.

Moyamoya is a possibility. The dye angiogram should more clearly define that.

A diffuse hypercoagulable state causing blockage in ACA, MCA, and PCA? Could be, but one would also expect possible blockages in arteries elsewhere in the body.

If the arterial pathology is really as diffuse as the MRA suggests, then a single AVM would not explain it. Further, most AVMs bleed or cause seizures, rather than merely occlude, but the imaging studies don't show a parenchymal hemorrhage.

I hope this helps. This must be a trying time for you (I have a two year old). I wish your child a speedy recovery and strength for everyone in the family. CCF MD mdf.

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