Trends in Clinical and Medical Sciences
Special issue: Recent developments of medical and surgical research (2023), pp. 584 – 588
ISSN: 2791-0814 (online) 2791-0806 (Print)
DOI: 10.30538/psrp-tmcs2023.si-rdmsr082
ISSN: 2791-0814 (online) 2791-0806 (Print)
DOI: 10.30538/psrp-tmcs2023.si-rdmsr082
Hyperhomocysteinemia and paediatric stroke: A case series
Anuja Sonika\(^{1}\), Kinikar Utkarsha S\(^{1}\) and Dhanawade Sara S\(^{1,*}\)
\(^{1}\) Department of Paediatrics, Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli, Maharashtra, India.
Correspondence should be addressed to Dhanawade Sara S at sarasubodh@yahoo.com
Copyright © 2023 Anuja Sonika, Kinikar Utkarsha S and Dhanawade Sara S. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: April 15, 2023 – Accepted: May 26, 2023 – Published: May 28, 2023
Abstract
Background: Cerebrovascular disease in children is a rare occurrence with an annual incidence of 2.7/100,000 children. There are limited reports revealing stroke in pediatric population associated with hyperhomocysteinemia. We present a series of cases discussing the clinicolaboratory, radiological findings and management of children presenting with hyperhomocysteinemia and stroke.
Aim and Objective: To study the clinicolaboratory profile, radiological findings and outcome of children with hyperhomocystienemia and stroke.
Aim and Objective: To study the clinicolaboratory profile, radiological findings and outcome of children with hyperhomocystienemia and stroke.
Methodology: This is a retrospective observational study where case records of paediatric patients (<18 years) who had stroke associated with Hyperhomocysteinemia were studied. Over the last five years, seven were diagnosed with hyperhomocystienemia associated with paediatric stroke.
Results: Out of the seven patients, six of them presented with headache and hemiparesis, one presented with convulsions. Mean age of presentation was 9 $\pm$1.5 years. Neuroimaging in all suggested acute cerebrovascular infracts. All had elevated homocysteine levels and five had documented low vitamin B12 levels. MTHFR gene was positive in one patient. Bilateral lens dislocation was observed in three of them. Intellectual disability was observed in four of these patients, and marfanoid features were seen in three of them. All the patients were started on low dose aspirin and polyvitamin therapy. Four patients had complete recovery, one is still improving and one was lost to follow up. Recurrence was observed in one patient.
Conclusion: Commonest symptoms were headache and hemiparesis. Manifestations of hyperhomocysteinemia can start in infancy. Homocystiene estimation should be included in work up of paediatric stroke and polyvitamin therapy should be included in management.
Results: Out of the seven patients, six of them presented with headache and hemiparesis, one presented with convulsions. Mean age of presentation was 9 $\pm$1.5 years. Neuroimaging in all suggested acute cerebrovascular infracts. All had elevated homocysteine levels and five had documented low vitamin B12 levels. MTHFR gene was positive in one patient. Bilateral lens dislocation was observed in three of them. Intellectual disability was observed in four of these patients, and marfanoid features were seen in three of them. All the patients were started on low dose aspirin and polyvitamin therapy. Four patients had complete recovery, one is still improving and one was lost to follow up. Recurrence was observed in one patient.
Conclusion: Commonest symptoms were headache and hemiparesis. Manifestations of hyperhomocysteinemia can start in infancy. Homocystiene estimation should be included in work up of paediatric stroke and polyvitamin therapy should be included in management.
Keywords:
Hyperhomocysteinemia; Stroke; Pediatric stroke.