Author(s)

Antonella Palmieri¹, Martina Finetti², Marta Bertamino², Laura Banov³, Margherita Mancardi⁴, Giovanni Morana⁵, Salvatore Renna¹

¹Emergency Department, IRCCS Gaslini, Genoa, Italy.
²Pediatric Reumatology Unit, IRCCS Gaslini, Genova, Italy.
³Hemostasis and Trombosis Unit, IRCCS Gaslini, Genova, Italy.
⁴Neurology Unit, IRCCS Gaslini, Genova, Italy.
⁵Neuroradiology Unit, IRCCS Gaslini, Genova, Italy.

To analyze how the multidisciplinary clinical, biohumoral, instrumental approach to ALTE (Apparent Life Threatening Event) episode may discover cardiovascular disease in the newborn. Introduction: In the first year of life ALTEs concern 0.8% of access to Pediatric Emergency Department. The cause of apparent life-threatening events (ALTEs) in infants reflects a differential diagnosis that includes an array of congenital or acquired disorders. Approximately 10% - 25% of ap-parent life-threatening events may remain unexplained following a thorough evaluation. Case re-port: B. E., a 2-month-old child, in wellbeing, shortly before meal, during sleep, was not responsive to repeated stimulations; he was hypotonic and unresponsive. About 15 minutes later, he pre-sented a normal tone and state of consciousness. Evaluating the referred symptoms, diagnostic protocol for ALTE was started; the Angio-MRI brain performed as second line analysis showed a focal gliotic lesion at left striatal area. The cardiological evaluation with echocardiography detected a pervium foramen ovale (PFO), with minimum shunt left-right direction. At least, biohumoral tests revealed protrombin gene heterozygosis mutation. Conclusion: Apparent Life-Threatening Events are first manifestation of stroke in infant. Discussion: This report discloses how the multidisciplinary clinical approach is essential in ALTE. The exact management of ALTE patients is very important in situations like this, when the concomitant disease is rare. In fact, arterial stroke incidence in children > 28 days of life is estimated between 1.2 and 7.9 cases/100,000 child-ren/year. However, in the last 20 years, we observed an increased incidence of stroke, probably related to two main causes: a greater attention for this disease and a major survival of children with pathology that arrange for stroke thanks to a better prevention. In conclusion, it’s a fundamental multidisciplinary approach even in following months after the events.

Perinatal Stroke, Apparent Life-Threatening Events, Pediatric, Emergency, Pro-Thrombotic Factor, Congenital Heart Defect

Palmieri, A. , Finetti, M. , Bertamino, M. , Banov, L. , Mancardi, M. , Morana, G. and Renna, S. (2014) Perinatal Stroke and Apparent Life-Threatening Event: A Case Report. Open Journal of Emergency Medicine, 2, 62-66. doi: 10.4236/ojem.2014.23011.