Stroke and acute hemiparesis developing within 15 minutes to 72 hours (mean 16.3 hours) after minor head injury is reported in 8 children, 2-7 years of age (mean 6.2 yrs), at Johann Wolfgang Goethe University, Frankfurt, Germany. CT or MRI showed cerebral infarctions affecting branches of the middle cerebral (3), anterior cerebral (1), posterior cerebral (1), and basilar (3) arteries, and involving the basal ganglia, internal capsule, and brain stem. Prothrombotic risk factors (increase in lipoprotein and factor V Leiden mutation) were present in 2 children. Outcome at a mean of 3.9 year follow-up, classified by the Glasgow scale, was a moderate disability in 4, severe disability (2), non-disabling sequelae (1), and total recovery (1). Minor head injury may explain some cases of so called “idiopathic” strokes. [1]

COMMENT. Stretching and shearing forces imposed by minor head injuries can lead to a traumatic endothelial intimal lesion of small intraparenchymal end arteries. This is followed by fibrin accumulation, leukocyte reaction and formation of a white thrombus that occludes the arterial lumen after a latency period. The minor trauma may be the only cause of stroke or a co-factor in etiology in cases having a prothrombotic or other known risk factor. A recent media publicized and alleged case of a child developing a cerebral hemorrhage or stroke following a ride on a roller coaster may represent an under-recognized example of minor head injury as a precursor of stroke in young children. Risk factors for hemorrhagic stroke in children include vascular malformation, malignancy, trauma, and coagulation disorders.