An Important Pediatric Stroke Mimic: Hemiplegic Migraine.

Stroke is relatively rare in children but has become increasingly recognized clinically. Hemiplegic migraine (HM) is a rare subtype of migraine, with attacks typically beginning in childhood or adolescence. Attacks are characterized by migraine headaches and motor weakness, which develop over several minutes. HM may therefore mimic acute stroke; however, symptoms last less than an hour and resolve spontaneously, often without sequela.1-4 Distinction between these entities is important due to their different urgency and management. Neuroimaging is indispensible in working up patients presenting to the Emergency Department with stroke-like symptoms and can be used to distinguish between infarction and HM.

Silent infarcts in young children with sickle cell disease.

Silent infarcts have been reported most commonly in school-aged children with homozygous sickle cell disease (SCD-SS) and are associated with neurocognitive deficits. However, the prevalence of silent infarcts in younger children with SCD-SS is not well defined. In this retrospective study, brain magnetic resonance imaging and angiography (MRI/A) studies performed before 6 years of age in a cohort of children with SCD-SS were analysed and the prevalence of abnormalities was calculated. Clinical and laboratory parameters were compared between the groups with and without silent infarcts. Sixty-eight of 96 children in the cohort had brain MRI/A performed prior to age 6 years. Of the 65 who were neurologically asymptomatic, 18 (27.7%, 95% CI 17.3-40.2%) had silent infarcts (mean age 3.7 +/- 1.1 years, range 1.3-5.9 years). Factors associated with silent infarcts included cerebral vessel stensosis by magnetic resonance angiography, lower rates of vaso-occlusive pain and acute chest syndrome and lower haemoglobin levels. The prevalence of silent infarcts in young children with SCD-SS is similar to that of older children and anaemia and severe vasculopathy may be risk factors.