title: [Recurrent idiopathic cerebral infarction in a 5-year-old boy, with emphasis on the importance of platelet aggregation analysis for appropriate selection of anti-platelet drugs].
abstract: We present a 5-year-old boy with recurrent idiopathic cerebral infarction in which analysis of platelet hyperaggregability was useful in choosing appropriate anti-platelet drugs. The patient presented with gait disturbance at the age of 5 years and 1 month. Brain MRI demonstrated multiple infarctions in the right thalamus and left cerebellum. There were no apparent underlying diseases including hematological, cardiac and vascular abnormalities. He was diagnosed as idiopathic cerebral infarction. First, we administered ticlopidine and he remained stable with persistent mild intention tremor in the left upper extremity for 4 months. Then he developed the second stroke at the age of 5 years and 5 months, and multiple infarctions in the right celebellum and cerebellar vermis were demonstrated. On platelet aggregation analysis, adenosine diphosphate (ADP)-induced aggregation was inhibited, probably due to ticlopidine administration. Collagen- and epinephrine-induced platelet aggregation showed hyperaggregation, so we started to administer cilostazol, which inhibits only epinephrine-induced hyperaggregation. We also added aspirin, which inhibits collagen-induced hyperaggregation. The combination of anti-platelet drugs inhibited epinephrine-, collagen- and ADP-induced hyperaggregation in this patient. He has been stable on the triple combination of anti-platelet drugs without further episodes of cerebral infarction or transient ischemic attack for 4 years to date. Appropriate selection of anti-platelet therapy was achieved by the simple and repeatable platelet aggregation analyses, which must be considered even in pediatric patients with cerebral infarction.
authors.affiliation: Department of Pediatrics, Tokai University School of Medicine, Isehara, Kanagawa. nobuyosi@is.icc.u-tokai.ac.jp
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Sugiyama
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Matsuda
authors.forename: Mie
authors.initials: M
authors.lastname: Shimizu
authors.forename: Saori
authors.initials: S
authors.lastname: Obara
authors.forename: Mariko
authors.initials: M
authors.lastname: Ikegami
authors.forename: Jyun-ichi
authors.initials: J
authors.lastname: Yokoyama
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miyashita
authors.forename: Shyunya
authors.initials: S
authors.lastname: Takizawa
authors.forename: Shigeharu
authors.initials: S
authors.lastname: Takagi
mesh_terms: D000244:Adenosine Diphosphate; D001241:Aspirin / Q000627:therapeutic use; D001780:Blood Coagulation Tests; D002544:Cerebral Infarction / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D002675:Child, Preschool; D000077407:Cilostazol; D003094:Collagen; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000191:economics / Q000235:genetics; D006801:Humans; D008297:Male; D010974:Platelet Aggregation; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012008:Recurrence; D013777:Tetrazoles / Q000627:therapeutic use; D013988:Ticlopidine / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000244:Adenosine Diphosphate; D003094:Collagen; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin; D004837:Epinephrine