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Pediatric Rehabilitation

Right Sided Motor Deficits after A Left ACA Stroke in a Child with Vascular Abnormalities: A Case Report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 10
Has Audio

    Poster Presenter(s)

  • Elliott Paintsil, MS

    Medical Student
    Medical College of Wisconsin
    Elm Grove, Wisconsin

    • Co-Author(s)

  • KG

    Karin Goodfriend, MD

    Associate Professor
    Medical College of Wisconsin Affiliated Hospitals PM&R Program
    Brookfield, Wisconsin

Disclosure(s):
Elliott Paintsil, MS: No financial relationships to disclose
Case Diagnosis: A four-year-old male with history of mild conductive hearing loss, congenital cataracts, and developmental delay presenting with stroke-like deficits.

Case Description or Program Description: A four-year-old male with history of developmental delay presented to the ED with 2-day history of fevers and an approximate 3-hour history decreased arousal with right-sided weakness, concerning for stroke. His mother reported a similar episode of right leg weakness the week prior, which resolved spontaneously. Imaging confirmed a left anterior cerebral artery (ACA) ischemic stroke secondary to left internal carotid artery (ICA) was occlusion. Of note, the right ICA showed an abnormal beaded appearance but remained patent. Lab work up positive for Influenza A. The patient was admitted to the PICU, started on heparin, aspirin and broad-spectrum antibiotics.

Neurology recommended repeat imaging on day 3 that revealed new infarcts in the right basal ganglia and left parietal cortex. His started working the Physical therapy and Occupational therapy however progress slowed when on day 8 he was found to be encephalopathic. Additional work up revealing a new right basal ganglia infarct. The primary team pursued an extensive workup for autoimmune, coagulation, inflammatory, infection, and nutritional etiologies. Based on input from multiple consults felt to be due to underlying vascular pathology exacerbated by Influenza A vs cryptogenic stroke.

Setting: Tertiary care pediatric hospital

Assessment/Results: By day 25, he demonstrated showed steady motor improvements and was ambulate short distances and manipulate small objects. Physical Medicine and Rehabilitation team was monitoring readiness for admission to acute inpatient rehabilitation and medical readiness.

Discussion (relevance): This case highlights the complexity of pediatric stroke management, emphasizing early therapy and close coordination with subspecialty teams

Conclusions: Managing strokes of unknown etiology in children with developmental delay requires vigilant monitoring, structured care, and ongoing multidisciplinary collaboration to support optimal recovery and prevent long-term disability.