Acute Hemiplegia and Facial Palsy 4-Months after Acute Kawasaki Disease in a 31-Month Old Girl

Kawasaki disease (KD) is an acute systemic vasculitis of unknown pathogenesis that affects small and medium-size blood vessels. Coronary arterial lesions are the best known KD complications but many others are well known and involve various anatomical districts in the acute and sub-acute period of KD. Cerebral infarction revealed by acute neurological manifestations is extremely rare, and till now true stroke events were reported only in the acute or sub-acute stage of patients with KD. We describe a 31-month-old girl referred to our Paediatric Emergency Unit for the appearance of left hemiplegia and facial palsy 4-months after an acute episode of an uncomplicated KD. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) showed hyperintensity lesions due to cerebral infarction in the absence of thrombosis or aneurysms of medium and large-vessels. Recently, the use of MRI and/or SPECT in KD patients has outlined a great variability in cerebro-vascular involvement showing various degrees of cerebral hypoperfusion, with or without neurological symptoms. Considering the normality of MRA studies in our patient we can assume that the appearance of stroke is due to a progressive degeneration of her small vessels leading to an arteritic complication that was not completely resolved after the previous acute KD illness. In conclusion and in order to prevent long-term arteritic vascular damage, probably anti-platelet therapy should be continued for more than 6 to 8 weeks also in patients without coronary aneurismatic degeneration in the early KD stage.