SHM Converge Scientific Abstract ePoster Gallery-The Sinister Side of Croup

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This case report describes a previously healthy 2-year-old boy who presented with fever, barky cough, and acute left-sided weakness after an upper respiratory illness. Initial evaluation showed a right-sided arterial ischemic stroke, with MRI suggesting focal cerebral arteriopathy (FCA). He was treated with aspirin, permissive hypertension, and supportive care, and improved enough to begin rehabilitation, though he remained weak and dysphagic.<br /><br />Three weeks later, he was readmitted with new right-sided weakness, focal seizures, and a new left-sided infarct. Repeat vascular imaging showed new collateral vessels and bilateral internal carotid artery tapering, confirming moyamoya disease. Infectious testing was notable for influenza, and earlier respiratory testing had also detected parainfluenza and rhino/enterovirus. Extensive workup, including echocardiography, hypercoagulable testing, cerebrospinal fluid studies, and moyamoya genetic testing, was unrevealing.<br /><br />The authors highlight that pediatric arterial ischemic stroke is rare but serious, with high mortality and frequent long-term neurologic deficits. Cerebral arteriopathies, especially moyamoya disease and FCA, are major causes of childhood stroke and carry substantial recurrence risk. Moyamoya is classically characterized by progressive narrowing of the internal carotid and related arteries, producing a “puff of smoke” appearance on imaging.<br /><br />The key takeaway is that this child’s stroke may have been triggered or unmasked by viral upper respiratory infections, an association that is suspected but not well established. The report emphasizes the need for prompt recognition of pediatric stroke symptoms, awareness that viral illnesses may be potential triggers, and further research into links between infections and cerebral arteriopathies.

Asset Subtitle

Ariel E. Carpenter

Meta Tag

Author List Ariel E. Carpenter, Chang Wu, Erin E. Shaughnessy

Category Clinical Vignettes

Concept Pediatric Arterial Ischemic Stroke

Concept Focal Cerebral Arteriopathy

Concept Moyamoya Angiopathy

Concept Arteriopathy

Concept Stroke Recognition

Distinguished Non-Finalist

Presenter Organization University of Alabama in Birmingham

Presenting Author Ariel E. Carpenter

Track Pediatric

Keywords

pediatric stroke

arterial ischemic stroke

focal cerebral arteriopathy

moyamoya disease

viral upper respiratory infection

influenza

parainfluenza

rhino/enterovirus

seizures

internal carotid artery stenosis

Pediatric Arterial Ischemic Stroke

Focal Cerebral Arteriopathy

Moyamoya Angiopathy

Arteriopathy

Stroke Recognition