Stroke in Toddler After Minor Head Injury: An Emerging Diagnostic Challenge

The diagnosis of ischemic stroke in toddlers in ED is a challenge due to non-specific neurological symptoms and difficulties in conducting a detailed neurological examination in toddlers. Magnetic Resonance Imaging (MRI) requires patient sedation and the cooperation of several medical personnel. A 33-month-old male presented with the immobility of the left upper extremity after a fall from a child chair. A head computerized tomography scan revealed no obvious bleeding. An orthopedic surgeon, a neurosurgeon, and a pediatrician were consulted but could not provide a definitive diagnosis. The following day, the patient developed left incomplete hemiplegia and dysarthria, and an emergency MRI detected a high signal at the right nucleus basalis. The patient was diagnosed with acute cerebral infarction and transferred to a children’s hospital. Pediatric minor head injuries and pulled elbows are commonly presented in ED, and most patients are discharged safely. Despite persistent neurological deficits several hours after arrival, we could not perform an MRI, which delayed the diagnosis. We recommend that early MRIs are performed in similar cases to aid rapid diagnoses. The collaboration between several specializations allowed the successful diagnosis and treatment of this case.