Posterior cerebral artery infarction associated with Mycoplasma pneumoniae infection in children

Abstract Acute ischemic stroke is a rare neurological complication of mycoplasma (MP) infection in children. We present two children with a MP respiratory infection who experienced posterior cerebral circulation stroke, which is particularly rare, and review the relevant literature. Both cases were pre-school children who initially acquired a respiratory illness then developed neurological signs including coma and seizure. Chest radiography revealed pneumonic infiltration with pleural effusion or pleural response. Anti-MP IgM antibody was positive. MP DNA was detected in the sputum using polymerase chain reaction analysis. Cerebrospinal fluid biochemical and pathological testing and MP DNA analysis were negative. D-dimer concentration was elevated. Neuroimaging showed posterior circulation occlusion and infarction. Clinical symptoms improved after treatment with erythromycin, anticoagulation, and thrombolysis; however, neurological sequelae remained and follow-up imaging revealed permanent effects. In our literature review, we identified 25 patients (including the two presented here) who developed an ischemic stroke as a complication of MP infection, 14 males and 11 females. Median age was six years (range, zero to 13) and average time between respiratory symptoms and stroke onset was 9 days. Nineteen strokes (76%) involved the anterior cerebral circulation; middle cerebral artery stroke was most prevalent (68%). Hemiparesis and seizure were the most common neurologic signs. Evidence of MP infection was found in the cerebrospinal fluid of five children. Coagulopathy affected nearly half. The most common treatments were macrolide antibiotics, immunoglobulin, glucocorticoid, and aspirin. Three patients (11%) died during follow-up, all from early respiratory deterioration. Thirteen children had varying degrees of permanent neurological sequelae. Cerebral infarction is a rare complication of MP infection in children and has a poor prognosis. Early identification of stroke risk factors and early intervention may improve outcomes.