Juvenile ischemic cerebral vascular disease was studied over a 15 year period in 34 patients in the Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical College, Tokyo, Japan. Intracranial occlusions were attributed to cerebral thrombosis or embolism in 23, and to Moya Moya disease in 11. An embolism based on congenital heart disease was found in 8, with trauma in 3, and with infection in 1. Cerebral angiography confirmed stenoses or occlusions in 17 of 21 patients tested. The initial symptoms of juvenile ischemic cerebral disease was hemiparesis in 22 (47.8%), convulsion in 9 (19.6%) and speech impairment in 7 (15.2%). The prognosis in patients with an unknown etiology for the occlusion had good outcomes whereas those with congenital heart disease had a relatively poor prognosis. Three patients had abscesses after their ischemic lesions. [1]

COMMENT. Cerebral arterial occlusion in children is uncommon and only 3% of cerebral infarctions occur in patients under the age of 40. A thorough diagnostic search to prevent recurrences is of importance in the young stroke victim. Despite a lengthy differential diagnosis of cerebral infarction several predominant etiologies account for the majority of cases. The category of uncertain etiology includes 35% of patients in whom the cerebral infarction was associated with mitral valve prolapse, migraine and oral contraceptive use. Each of these conditions is frequent enough in healthy young adults that causality cannot be assumed until other causes have been eliminated [2]. The causes of infarction in 100 young adults were listed as cerebral vascular atherosclerosis (18), cerebral embolism (31), cerebral vasculopathy (10), coagulopathy and systemic inflammation (9), peripartum (5), and uncertain etiology (27). Ergot preparations and oral contraceptives were contraindicated in patients with migraine headaches and cerebral infarction. Platelet antiaggregates were advised in migraine patients with cerebral infarction and in the idiopathic cases. In the present paper from Tokyo, some of the patients with arterial occlusion of unknown etiology had had frequent episodes of inflammation such as measles or tonsillitis in their past history and the occlusion and inflammation were thought to be indicative of arteritis. Patients with occlusion of the internal carotid artery often show pathological findings consistent with the early stages of Moya Moya disease in childhood. [3]