title: Minor head injury as cause and co-factor in the aetiology of stroke in childhood: a report of eight cases.
abstract: BACKGROUND
  Traumatic stroke usually occurs after dissection of large extracranial or intracranial vessels, leading to disseminated cerebral embolism. Stretching and distorting forces in cerebral intraparenchymal end arteries can cause intimal lesions followed by an occluding thrombus.
  
  
  OBJECTIVE
  To investigate the importance of traumatic endothelial lesions in intraparenchymal end arteries after minor head injuries.
  
  
  METHODS
  The cases of eight children are reported. They were aged between two and seven years (mean 6.2 years), and they developed significant neurological deficits at 15 minutes to 72 hours (mean 16.3 hours) after minor head injuries.
  
  
  RESULTS
  The the patients all had hemiparesis combined with other signs, including central facial paralysis, dysphasia, dysphagia, and extrapyramidal signs. Computed tomography or magnetic resonance imaging showed cerebral infarctions affecting branches of the middle cerebral artery (n = 3), anterior cerebral artery (n = 1), posterior cerebral artery (n = 1), and basilar artery (n = 3). These lesions affected the basal ganglia, the internal capsule, and the brain stem. Neither heart disease nor dissections of large vessels were present. Two children had prothrombotic risk factors (an increase in lipoprotein (a) and a factor V Leiden mutation). The follow up period was between three months and 13 years (mean 3.9 years). Outcome was classified according to the Glasgow outcome scale as moderate disability (n = 4), severe disability (n = 2), non-disabling sequelae (n = 1), and total recovery (n = 1).
  
  
  CONCLUSIONS
  Minor head injuries can be cause and co-factor in the aetiology of stroke. The frequency of this may be underestimated, and detailed medical history of the days before stroke manifestation may identify more traumatic events, especially in the group of so called "idiopathic" strokes.
authors.affiliation: Department of Paediatrics, Paediatric Neurology, Johann Wolfgang Goethe University, Frankfurt/Main, Germany. matthias.kieslich@kgu.de
authors.forename: M
authors.initials: M
authors.lastname: Kieslich
authors.forename: A
authors.initials: A
authors.lastname: Fiedler
authors.forename: C
authors.initials: C
authors.lastname: Heller
authors.forename: W
authors.initials: W
authors.lastname: Kreuz
authors.forename: G
authors.initials: G
authors.lastname: Jacobi
mesh_terms: D000059:Accidents; D001924:Brain Concussion / Q000150:complications* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology