Yezan Abderrahman, MD
Pediatric Critical Care Fellow
University of Iowa Hospital and Clinics
Iowa City, IA, United States
Disclosure information not submitted.
Niranjan Vijayakumar, MD
Boston Children's Hospital
Boston, Massachusetts
Disclosure information not submitted.
Aditya Badheka, MD, MS
Clinical Associate Professor, Pediatric Critical Care
University of Iowa Hospital and Clinics
Iowa City, Iowa, United States
Disclosure information not submitted.
Madhuradhar Chegondi, MD
Clinical Associate Professor, Division of Pediatric Critical Care Medicine
University of Iowa Stead Family Childrens's Hospital
Iowa City, IA, United States
Disclosure information not submitted.
Title: A Case of Acute Ischemic Stroke in a Toddler With Severe Iron Deficiency Anemia
Case Report Body:
Introduction: Iron deficiency anemia is frequently asymptomatic and can often go undiagnosed. Severe anemia can manifest as neurologic involvement primarily as behavioral disorders and developmental delay. Hearing loss and peripheral neuropathies have been described in this setting as well. Cerebrovascular accidents in association with iron deficiency anemia is rarely reported in literature, especially in the pediatric patient population.
Description: Here we present a 4-year-old male previously healthy who presented to our pediatric intensive care unit with a history of headaches, unsteady gait and avoiding weight-bearing in the lower extremities with multiple falls reported at the daycare. He was subsequently taken to urgent care with femoral and hip X-rays nonrevealing. He started having increasing weakness of the left side, more notable in lower than upper extremities which prompted a visit to the Emergency Department. CT brain revealed right sided hypodensity concerning for ischemic stroke and laboratory studies were remarkable for hemoglobin (HGB) of 4.3 g/dl, mean corpuscular volume (MCV) 59 fL, and Ferritin 2.2 ng/ml. Upon arrival to our hospital patient had additionally an MRI which showed multiple foci of acute infarcts in the right cerebral hemisphere and a focus of chronic infarct in the left cerebral hemisphere. His blood pressure was 100/58 mmHg and heart rate 144 bpm, SpO2 >92% on 2L nasal cannula. He received around 200 mLs of packed red blood cells along with intravenous iron infusion 7 ml/kg. Transthoracic echocardiography didn’t reveal patent foramen ovale (PFO) or any evidence of right-to-left shunting. He also received extensive hematologic, infectious, immunologic, and rheumatologic work-up that wasn’t suggestive of any other potential etiology for the stroke or the anemia. The patient demonstrated significant improvement in left upper and lower extremity strength and was subsequently discharged from the hospital on Aspirin 81 mg daily and oral iron supplementation.
Discussion: Iron deficiency anemia remains a prevalent problem in children, although most times asymptomatic. Neurologic involvement with acute ischemic stroke has been rarely reported in adult literature. Our index patient describes this risk in the pediatric patient population as well. Mortality and morbidity can be significant.