Elevated serum lipoprotein(a) as a risk factor for combined intracranial and extracranial artery stenosis in a child with arterial ischemic stroke: A case report.

RATIONALE

Stroke is an uncommon disease in childhood with an estimated incidence of 1 to 6 per 100,000 and stenoocclusive arteriopathy is the main risk factor of recurrent pediatric arterial ischemic stroke (AIS). Dyslipidemia may influence strongly before puberty and in late adolescence when plasma levels are naturally highest.

PATIENT CONCERNS

An 11-year-old male presented with acute onset seizure, a drowsy mentality, and right hemiplegia.

DIAGNOSES

Magnetic resonance (MR) angiogram demonstrated occlusion of distal basilar artery and left vertebral arteries. Serum Lp(a) was significantly increased as 269 nmol/L (normal<75 nmol/L) only. Thus, he was diagnosed as pediatric AIS.

INTERVENTIONS

He was started on aspirin (100 mg/day) for secondary stroke prevention and received nicotinic acid (2 g/day) as a Lp(a)-lowering agent.

OUTCOMES

Consciousness gradually improved and the patient regained a normal orientation after 2 weeks. The Lp(a) level was reduced to 48 nmol/L after nicotinic acid administration.

LESSONS

High Lp(a) level may be considered in the risk profile assessment of pediatric AIS. Niacin and certain inhibitors of cholesteryl ester transfer protein can be considered to reduce Lp(a).