A fatal pediatric case with dizziness originating from multiple cerebral infarctions

Abstract

We report the case of a 14-year-old male patient with dizziness originating from multiple cerebral infarctions. He presented at our hospital with vertigo onset during a soccer game. He had a family history of collagen disease. Although a physical examination revealed a left-beating horizontal nystagmus upon a left gaze, a CT scan showed no abnormalities. He was diagnosed as having acute peripheral vertigo and was hospitalized in our department. On the second day of his admission, he developed a right eye adduction disorder and was referred to the neurology department. On day 3, an MRI revealed acute infarctions in the cerebellum, midbrain and crus posterus capsulae internae. Treatment with heparin and edaravone was immediately begun. On day 4, anisocoria and respiratory disturbance were noted; a second MRI was performed, revealing brain swelling. Although therapeutic hypothermia was initiated to prevent brain death, the patient's general condition gradually worsened and he died on day 16. A blood sample sent to another facility tested positive for lupus anticoagulant, suggesting a diagnosis of catastrophic antiphospholipid antibody syndrome. In patients presenting with acute vertigo, a head MRI should be immediately performed if a family history of collagen disease is present, even in pediatric cases.