Thromboembolic infarcts occurring after mild traumatic brain injury in a paediatric patient with Noonan's syndrome.
Noonan's syndrome is a genetic concurrence of multiple morphological abnormalities typified by short stature, webbed neck, cardiovascular abnormalities, and characteristic facies. Numerous neurological conditions have also been associated with Noonan's syndrome, including cerebrovascular pathology. This paper describes the case of a 15-year-old female on our paediatric rehabilitation service who, in a motor vehicle accident, suffered a mild traumatic brain injury (TBI) which was followed by multiple thromboembolic infarcts of the posterior circulation. Full work-up resulted in the diagnosis of Noonan's syndrome and the demonstration of significant posterior circulation congenital anomalies. Traumatic vasculopathy, superimposed on the developmentally hypoplastic posterior vessels, was suggested as an aetiology of this patient's stroke. A review of the limited literature associating thromboembolic infarcts with antecedent TBI, and linking Noonan's syndrome to various neurological problems, is discussed. This paediatric rehabilitation case represents a fascinating new association between thromboembolic infarcts and TBI in the setting of a previously undiagnosed genetic syndrome.
Department of Physical Medicine and Rehabilitation, Medical College of Virginia, Richmond 23298.
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D000293:Adolescent; D001930:Brain Injuries / Q000150:complications*; D002544:Cerebral Infarction / Q000209:etiology*; D005260:Female; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000209:etiology*; D009634:Noonan Syndrome / Q000150:complications*