A pediatric case of cerebral infarction following minor head injury presenting interesting neuroradiological findings

We reported a case of juvenile cerebral infarction following minor head injury. The patient, a 12-year-old girl, developed right hemiparesis and aphasia almost immediately after having fallen from about 1 meter height during the exercise class at school. CT and MRI study showed lacunar lesions bilaterally and almost symmetrically in the paraventricular deep white matter on both sides. A new stroke area, responsible for the symptoms, was recognized about 24 hours later on CT scan just next to the lacuna of the left side. Although angiography revealed a rare anomaly of the right side aortic arch, associated with subclavian steal phenomenon, presumably of congenital in nature, no abnormality was found in the intracranial vessels. She made a rapid recovery during her hospital stay and showed no more than a slight motor weakness in her right upper extremity on discharge. The literature was reviewed on the embryology of the aortic arch and brachiocephalic arteries. We speculate that the lacunar lesions found bilaterally are dilated large normal Virchow-Robin space, and the pathogenesis of the stroke in this patient was discussed.