Title : Pediatric ischemic stroke in a post-COVID-19 context: A case report of left hemiplegia
Abstract:
Introduction: Pediatric ischemic stroke is rare and differs from adult stroke in terms of clinical presentation, risk factors, etiology, management, and functional outcomes. Neurological complications have been reported following COVID-19 infection in children, including cerebrovascular events. Because the infant brain is still developing, stroke may significantly affect psychomotor development. We report a case of left hemiplegia secondary to ischemic stroke in a post-COVID-19 context, highlighting the role of early rehabilitation and family involvement in functional recovery.
Case Report: A 9-month-old infant with normal psychomotor development was admitted to the pediatric emergency department for sudden-onset left-sided motor weakness. The child had a history of asymptomatic COVID-19 infection two months earlier, documented by positive serology. Thrombophilia screening, cardiac assessment, and investigations for cerebral arteriovenous malformations revealed no abnormalities.
Brain imaging showed an ischemic stroke with hemorrhagic transformation. Ten days after stroke onset, Physical and Rehabilitation Medicine assessment revealed complete left hemiplegia with mild spasticity (Modified Ashworth Scale [MAS] score: 1), reducible flexion of the left fingers, and left ankle equinus. Sitting balance was impaired, while standing and walking were impossible, indicating regression of previously acquired motor skills.
An individualized rehabilitation program was initiated, including prevention of contractures and abnormal postures, joint mobilization, muscle activation, postural control, progressive standing and gait training, upper-limb functional activities, and occupational therapy through age-appropriate play activities. The mother was actively involved throughout the rehabilitation program.
Results: Clinical and functional assessments were performed at 3, 6, and 12 months. No trophic or orthopedic complications were observed. At 6 months, standing and walking were possible with assistance, although the left upper limb remained non-functional. At 12 months, motor control had improved in both the upper and lower limbs, gross grasp was possible, and fine motor function had begun to recover. The child was able to walk without a technical walking aid while wearing supportive footwear. Spasticity remained mild (MAS score: 1).
Conclusion: Pediatric stroke may lead to significant regression of motor development and requires early, individualized, and developmentally adapted rehabilitation. This case illustrates favorable functional recovery following a structured rehabilitation program, particularly regarding gait and gross motor function. Continuous adaptation of rehabilitation to the child’s developmental stage and active parental involvement are essential components of management.
Keywords: Pediatric ischemic stroke; Hemiplegia; COVID-19; Rehabilitation; Infant.
