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Case report
Postintravenous immunoglobulin stroke in a toddler with Down syndrome: a diagnostic challenge
  1. Teck-Hock Toh1,2,3,
  2. Everlyn Coxin Siew1,3,
  3. Chae-Hee Chieng1,3 and
  4. Hussain Imam Mohd Ismail4
  1. 1Department of Paediatrics, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia
  2. 2Clinical Research Centre, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia
  3. 3Faculty of Medicine, SEGi University, Kota Damansara, Selangor, Malaysia
  4. 4Department of Paediatrics, Penang General Hospital, Georgetown, Pulau Pinang, Malaysia
  1. Correspondence to Professor Teck-Hock Toh; tohth{at}moh.gov.my

Abstract

Children with Down syndrome have a higher risk of stroke. Similarly, intravenous immunoglobulin (IV Ig) is also known to cause a stroke. We reported a 3-year-old boy with Down syndrome who presented with severe pneumonia and received IV Ig. He developed right hemiparesis 60 hours after the infusion. Blood investigations, echocardiography and carotid Doppler did not suggest vasculitis, thrombophilia or extracranial dissection. Brain computerised tomography (CT) showed acute left frontal and parietal infarcts. Initial magnetic resonance angiography (MRA) of cerebral vessels showed short segment attenuations of both proximal middle cerebral arteries and reduction in the calibre of bilateral supraclinoid internal carotid arteries. The boy was treated with enoxaparin and aspirin. He only had partial recovery of the hemiparesis on follow-up. A repeat MRA 13 months later showed parenchymal collateral vessels suggestive of moyamoya disease. We recommend imaging the cerebral vessels in children with a high risk of moyamoya before giving IV Ig.

  • stroke
  • moyamoya
  • immunological products and vaccines
  • congenital disorders
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Footnotes

  • Contributors T-HT conceptualised and designed the manuscript, critically revised the manuscript as submitted and approved the final manuscript. ECS drafted the first draft of the manuscript and approved the final manuscipt. C-HC conceptualised and designed the manuscript, critically revised the manuscript as submitted and approved the final manuscript. HIMI critically revised the manuscript as submitted and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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