SUBCORTICAL INFARCTION IN CHILDREN

Background and Purpose This report examines the occurrence of subcorti cal infarction in 5 children, reviews the English literature, and disc usses evaluation of this uncommon childhood illness. Methods Clinical characteristics and neurological follow-up were examined in children w ho presented with subcortical infarction within the past 7 years. The English literature over the previous 20 years was reviewed to identify similar patients with radiological documentation of subcortical infar ction. Results Mean age of the patients in this series was 4.8 years ( range, 4 months to 12 years); 3 children were female. Three patients p resented with the sudden onset of hemiparesis, 1 with dystonia, and 1 with fever and focal seizures. Protein C deficiencies were demonstrate d in 2 children; a cardiomyopathy was seen in 1 patient. Mean follow-u p was 1.5 years. Two patients were neurologically normal, mild residua l symptoms persisted in 2, and 1 patient showed severe dystonia. The l iterature analysis indicated that specific risk factors were described in 79 patients; complete clinical analysis was available for 51 patie nts. In the latter group, the mean age was 5.7 years; 26 children were female. Forty-six presented with hemiplegia, 4 with dystonia, and 1 w ith focal seizures. Follow-up greater than 5 months in 29 patients sho wed complete or good resolution of deficits in 23. Specific risk facto rs such as infection, trauma, hematologic disorders, or cardiac or vas cular abnormalities were identified in 62 of 79 children. Conclusions This analysis indicates that children with subcortical infarction usua lly presented with acute hemiparesis. Risk factors were identified in the majority of children, and follow-up demonstrated good or complete resolution of neurological deficits in 80% of the patients.