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A premorbidly healthy 5-year-old male tripped and fell in his gym class at school while chasing a ball on October 8, 2013. He hit his head on bleachers. He did not lose consciousness, but was reportedly dazed when he saw the school nurse. No formal diagnostic work-up or treatment was deemed necessary at that time. On October 15, while walking with his mother, she noticed that he suddenly looked tired and that the right side of his face was drooped. He was also noted to be staggering when he walked and for a period of time had difficulty responding verbally to her. He was taken promptly to a hospital on October 16 and identified to have acute onset of right facial droop, mild rightsided weakness and an unsteady gait. A MRI/MRA of the brain revealed a left thalamic stroke. A C-spine MRI showed C1-C2 and C4-C5 ligamentous injury for which he was placed in a cervical collar for 6 weeks. He was admitted to an inpatient rehabilitation unit on October 22 for comprehensive therapies and ongoing medical management.
What is the most likely cause of this child’s sudden stroke?
No one correctly answered last issue’s Make the Diagnosis. The correct diagnosis is parasitic infection, the topic of this issue’s cover story.
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