Pediatric acute ischemic stroke: unusual presentation with dizziness neurological symptoms in a young child: a case report

Introduction: Pediatric acute ischemic stroke (AIS) is an uncommon yet critical condition with a pooled incidence rate of 1.28 per 100 000 person-years. Unlike adult strokes, pediatric AIS often lacks standardized recognition protocols and presents with non-specific symptoms such as dizziness and vomiting, which can lead to significant diagnostic delays. Case presentation: We report the case of a previously healthy 7-year-old boy presenting with dizziness and projectile vomiting, followed by transient neurological deficits including quadriparesis and dysphagia. While the initial physical examination in the emergency department showed only gait ataxia, subsequent neuroimaging confirmed multifocal acute infarctions in the right cerebellum, right pons, and right posterior cerebral artery territory. Despite normal MR angiography, the distribution suggested a posterior circulation event. The patient was managed with antiplatelet therapy (aspirin 4 mg/kg/day, later titrated to 1 mg/kg/day) and supportive care. Further etiological workup for monogenic vasculopathies and thrombophilia was limited by parental preference. Conclusion: Pediatric AIS should be a primary consideration in the differential diagnosis for children with acute, unexplained neurological deficits, even when motor power appears preserved on initial examination. This case highlights the diagnostic challenge of posterior circulation strokes and the necessity of considering rare genetic vasculopathies such as DADA2 in idiopathic cases. Categories: Pediatrics.