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Arterial Ischemic Stroke in a Child with ß-Thalassemia Trait and Methylentetrahydrofolate Reductase Mutation

Clinic for Child Neurology and Psychiatry, Medical Faculty, University of Belgrade, Serbia, vladas{at}infosky.net

Vedrana Milic Rasic, MD, PhD

Clinic for Child Neurology and Psychiatry, Medical Faculty, University of Belgrade, Serbia

Valentina Djordjevic, MSc

Institute of Molecular Genetics and Genetic Engineering, Belgrade, Serbia

Milos Kuzmanovic, MD

Mother and Child Health Institute of Serbia Dr Vukan Cupic, Belgrade, Serbia

Sonja Pavlovic, PhD

Institute of Molecular Genetics and Genetic Engineering, Belgrade, Serbia

Genetic and acquired disorders that foster a procoagulable state represent risk factors for stroke in childhood. Although an increased incidence of thromboembolic complications has been reported in patients with thalassemia, severe cerebral thromboembolism has rarely been observed in patients with ß-thalassemia minor. This article describes a case study of a 1-year-old boy who presented with left-sided hemiparesis, seizures, microcytic anemia, and recent infection with reactive thrombocytosis. Ischemic infarction in the territory of the right middle cerebral artery was confirmed by magnetic resonance imaging and magnetic resonance angiography. Genetic tests showed that the patient was heterozygous for the ß°-thalassemia IVS-I-1 mutation and homozygous for the methylentetrahydrofolate reductase C677T mutation. Based on these findings, it was concluded that the synergistic effects of multiple, genetic, and acquired prothrombotic risk factors brought about the hypercoagulable state that resulted in overt stroke in a thalassemic patient in early childhood.

Key Words: stroke • ß-thalassemia trait • MTHFR mutation

Journal of Child Neurology, Vol. 22, No. 2, 208-210 (2007)
DOI: 10.1177/0883073807300306


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