Mineralizing angiopathy with basal ganglia stroke

A 1.5-year-old male child presented with difficulty in walking and weakness of the left upper and lower limbs which developed after a minor fall while playing 2 days back, as noticed by the mother. He was referred to our department for magnetic resonance imaging of the brain which revealed acute infarct in the right lentiform nucleus. Magnetic resonance time-of-flight angiography showed no significant abnormality with normal course and caliber of the right middle cerebral artery [Figure 1].

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Figure 1:

(a) Axial diffusion and (b) apparent diffusion coefficient images show acute infarct in the right lentiform nucleus. (c) Time-of-flight magnetic resonance angiogram shows normal signal in intracranial vasculature with no major vessel occlusion.

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Unenhanced computed tomography (CT) scan of the brain revealed linear calcifications in both the basal ganglia along the lenticulostriate arteries suggesting the diagnosis of mineralizing angiopathy [Figure 2].

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Figure 2:

(a) Unenhanced axial and (b) coronal reformatted maximum intensity projection computed tomography images of the brain show linear calcification along the lenticulostriate arteries on both sides (yellow arrows in a and b) and hypodense infarct in the right lentiform nucleus (red arrow in a).

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Mineralizing angiopathy is a cause of basal ganglia stroke in infants. It has good long-term outcome with standard antithrombotic therapy. Therefore, correct diagnosis by imaging is required to avoid a battery of other investigations for infantile stroke like prothrombotic workup.^[1]

Thin-sliced CT with multiplanar reconstruction is the investigation of choice to pick up the linear calcification of these vessels.