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Journal of Child Neurology
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Article

Recovery From Spatial Neglect and Hemiplegia in a Child Despite a Large Anterior Circulation Stroke and Wallerian Degeneration

Jonathan T. Kleinman, BA1, Philippe Gailloud, MD2, and Lori C. Jordan, MD, PhD3*

1 Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
2 Division of Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
3 Department of Neurology, Division of Pediatric Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland

* To whom correspondence should be addressed. E-mail: ljordan2{at}jhmi.edu.


  Abstract
Prognosis after stroke in children is difficult given the paucity of literature regarding motor and cognitive recovery. Spatial neglect has been described in children after stroke, yet little evidence exists to guide clinicians and parents regarding its resolution. Wallerian degeneration on magnetic resonance imaging (MRI) suggests poor recovery in neonates and adults. We report near complete resolution of spatial neglect in 4 weeks and significant improvement in hemiplegia in a 9-year-old boy with a right anterior cerebral artery and middle cerebral artery infarction, despite Wallerian degeneration apparent on diffusion-weighted imaging. Serial assessment of neglect documenting the rapid course of recovery is the unique feature of this case and may help serve as a guide to pediatricians and neurologists in assessment of young patients and counseling of parents. The lack of published outcome data suggests a need for larger studies about the recovery of spatial neglect and other cognitive symptoms following pediatric stroke.

First published on October 21, 2009
Journal of Child Neurology 2009, doi:10.1177/0883073809339060
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