Twice Unlucky - Bilateral Basal Ganglia Stroke After Minor Head Injury in Children With Mineralizing Lenticulostriate Vasculopathy.

BACKGROUND: Basal ganglia stroke after minor head trauma in children with mineralizing lenticulostriate vasculopathy is almost always unilateral, and the occurrence of simultaneous infarction of bilateral basal ganglia is extremely rare. METHODS: Retrospective charts review of children with mineralizing lenticulostriate vasculopathy who sustained simultaneous bilateral basal ganglia stroke after minor head trauma. RESULTS: Of the total 38 children with mineralizing lenticulostriate vasculopathy who presented with acute basal ganglia stroke after minor head trauma, 4 (10.5%) had simultaneous bilateral infarction. These included two boys and two girls, aged 5-22 months at the time of stroke onset. All had experienced minor head trauma which preceded the stroke by 5 minutes in one child, 30 minutes in two children, and 9 hours in one child. Clinical presentation included hemiplegia in all 4 children, focal seizures in 3, and encephalopathy in 2. Head computed tomography revealed punctate basal ganglia calcification in all four on axial images, while brain magnetic resonance imaging showed diffusion restriction and low apparent diffusion coefficient in the bilateral striato-capsular regions. Three children had microcytosis, though only one child was anemic. All 4 children were treated with oral aspirin and iron supplementation. At follow-up, two children had mild residual hemiparesis at 10 and 24 months, respectively. One child had minimal deficits at 30 months. One child was lost to follow-up. CONCLUSIONS: The occurrence of simultaneous bilateral basal ganglia stroke following minor head trauma in children with mineralizing lenticulostriate vasculopathy is rare. The risk factors for this phenomenon remain unknown.