LARGE VESSEL OCCLUSION STROKE IN A 17 YEAR OLD MALE WITH PAEDIATRIC INFLAMMATORY MULTI-SYSTEM SYNDROME ASSOCIATED WITH SARS-COV-2
European Stroke Journal
; 7(1 SUPPL):361, 2022.
Article
in English
| EMBASE | ID: covidwho-1928102
ABSTRACT
Background:
Paediatric Cov-2 infections have been less severe than in adults, however some have developed a newly defined syndrome, Paediatric Inflammatory Multisystem Syndrome associated with CoV-2 (PIMS -TS). Its presentation is variable and can cause multi-system involvement. It belongs to the common spectrum of pathogen-triggered hyperinflammatory states, including atypical Kawasaki disease. Casesummary:
17 year old male of Ghanaian origin, with no significant past medical history, presented with a one-week history of general malaise, fevers and sore throat. He developed severe chest pain and cardiogenic shock, with a CRP of 200, raised troponin and global hypokinesia on echocardiogram with an ejection fraction of 20%. He was positive for SARS-CoV-2 antibodies (though PCR-antigen negative at admission) and fit the criteria for myocarditis secondary to PIMS-TS. He was treated for sepsis, commenced on IV methylprednisolone and needed intubation, sedation and cardiothoracic ICU level care. On weaning sedation after 3 days, he was found to have left middle cerebral artery syndrome with NIHSS 16. CT head and CT angiogram showed a left MCA ischaemic stroke, and a thrombus in the Sylvian MCA branch. This was treated with antiplatelets. His disease markers and motor deficits improved significantly, however he has cognitive impairment and low mood.Conclusion:
PIMS-TS related LVO anterior circulation infarct is rare. It necessitates urgent recognition and multi-specialty involvement as currently management is not standardised. Axial DWI (A), ADC (B) MRI demonstrate large left MCA territory infarct. Axial MRA (C) shows occlusion of the left M2 branches, signal drop-out on SWI (D).
antigen; endogenous compound; methylprednisolone; SARS-CoV-2 antibody; troponin; adolescent; anterior circulation infarction; blood vessel occlusion; cardiogenic shock; case report; cerebrovascular accident; clinical article; cognitive defect; conference abstract; coronary care unit; echocardiography; heart ejection fraction; herpes labialis; human; human cell; hypokinesia; intubation; ischemic stroke; malaise; male; medical history; middle cerebral artery; mood; motor dysfunction; myocarditis; National Institutes of Health Stroke Scale; nonhuman; nuclear magnetic resonance imaging; pediatric multisystem inflammatory syndrome; sedation; sepsis; Severe acute respiratory syndrome coronavirus 2; thorax pain; throat; thrombocyte; thrombus; weaning
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Language:
English
Journal:
European Stroke Journal
Year:
2022
Document Type:
Article
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