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Special Feature
February 2, 2009

Picture of the Month—Quiz Case

Author Affiliations


Arch Pediatr Adolesc Med. 2009;163(2):179. doi:10.1001/archpediatrics.2008.520-a

A 2-month-old, previously healthy infant developed partial seizures, eventually controlled by phenobarbital, levetiracetam, and lamotrigine. The results of imaging studies and metabolic workup were normal. He was born full term after an uncomplicated pregnancy and delivery to healthy parents of Indian descent. His development had been unremarkable.

At the age of 5 months, he had a left hemiparesis due to a right anterior cerebral artery stroke. At the age of 11 months, he presented with a right hemiparesis and focal right-sided seizures from a left middle cerebral artery stroke (Figure 1). The results of cardiologic evaluation, including cardiac ultrasonography, were normal. Extensive hematologic workup and genetic screening for a hypercoagulable state were unrevealing. Magnetic resonance imaging and the concurrent magnetic resonance angiogram prompted a conventional 4-vessel angiogram (Figure 2).