Cardiogenic Embolism Treated Successfully by Intravenous Recombinant Tissue-Type Plasminogen Activator Administration in a Young Child With Congenital Heart Disease: A Case Report.

Childhood ischemic stroke is rare. Although the standard treatment for ischemic stroke among adults is thrombolytic therapy with recombinant tissue-type plasminogen activator (rt-PA), its use in pediatric patients remains uncertain. Particularly, only a very few reports have studied this treatment among very young children aged < 3 years. We report the case of a 2.5-year-old boy with complex congenital heart disease who developed left hemiparesis and impaired consciousness. Magnetic resonance (MR) imaging confirmed an acute infarct in the right parieto-occipital lobe. He presented with severe neurological deficits and was treated with rt-PA at 3.5 h after symptom onset. The rt-PA at an adult dosage of 0.6 mg/kg was administered as an intravenous bolus and infusion. Initial computed tomography showed no hemorrhage. Post-treatment imaging showed recanalization and no new hemorrhage. The patient exhibited remarkable neurological improvement and was neurologically intact at 12 h postadministration. Follow-up MR imaging performed on Day 16 showed no evidence of ischemia. MR angiography clearly demonstrated the right parieto-occipital artery, which was not depicted on the initial MR images. Our case represents a rare instance of the use of rt-PA in a young child. Despite limited data and absence of pediatric-specific guidelines, this report suggests that rt-PA is effective and can be administered safely in young children with acute ischemic stroke, mirroring adult treatment protocols. However, further research is necessary to establish definitive pediatric guidelines.