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1 Neuroradiologist.
2 Radiologist.
3 Medical Student.
Sixty-one of 176 children under the age of 14 years, who suffered an acute hemiplegia, underwent angiographic studies of the cranial vessels. This hemiplegia was not related to any intracranial mass lesion, infection, cardiac or hematologic abnormality. One or more lesions of the internal carotid artery and its branches or the vertebrobasilar system were demonstrated in 40 of these children.
The sites of these lesions have been classified into 3 groups:
Group I—Extracranial internal carotid or vertebral arterial disease
Group II—Unilateral intracranial arterial disease
(a)Internal carotid artery (complete or incomplete)
(b) Middle cerebral artery only
Group III—Bilateral intracranial arterial disease.
There was a distinct relationship between a history of a recent nasopharyngeal infection, exanthema, high fever, or severe exertion and the development of a hemiplegia in the great majority of these children. An additional discrete stenosis of the cervical portion of the internal carotid artery with distal intracranial arterial disease was demonstrated in 3 children, all of whom had had a recent nasopharyngeal infection. One child had bilateral intracranial internal carotid and renal artery disease prior to his hemiplegia, which followed a tonsillectomy. The concept of an undue sensitivity of the cerebral arteries or a pre-existing arteritis in some children is suggested, which, when associated with a nasopharyngeal infection or the effects of a systemic infection, results in an acute hemiplegia. This hemiplegia may thus be due to an arteritis itself or to associated thrombus and distal emboli.
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