To report presentation, imaging, and outcomes in three pediatric patients with basal ganglia stroke after minor head trauma. 

Stroke after minor head trauma in children is a rare occurrence that occurs in < 2% of all ischemic strokes in childhood. Basal ganglia and internal capsule are the most common regions affected, typically associated with lenticulostriate vasculopathy. 

 We retrospectively reviewed three pediatric patients who presented with stroke-like symptoms after sustaining a minor fall, and imaging showed acute ischemic basal ganglia infarctions. Demographics, clinical course and outcomes are described in this series.

Patients were between 16-38 months of age, and all presented with focal neurological deficits after minor head trauma. Deficits included hemiparesis (n=3), facial weakness (n=3), dysarthria (n=1). Symptom onset was stuttering in one patient. CT head showed basal ganglia calcifications in one, and hemorrhage in none. MRI/MRA of the brain  for all patients showed acute basal ganglia ischemic stroke which was bilateral in one case. Infectious, inflammatory and hypercoagulability workup for all patients was reassuring. One patient was started on anticoagulation pending work up, and two on antiplatelet agents, which were continued at discharge. Two patients were discharged to inpatient rehabilitation. One patient had complete neurological recovery by 2 months follow-up, one with partial recovery at six months (mRS=1), and one patient with pending follow-up.

 Basal ganglia stroke after minor head trauma is an under recognized and likely underreported entity in the pediatric population. It is believed that developmental anatomical peculiarities of the lenticulostriate arteries during infancy are responsible for their increased vulnerability to injury and thrombosis after minor head injury. This pediatric specific stroke syndrome tends to have a one-time occurrence with generally good neurological recovery. Thus, increasing awareness of this entity can help limit unnecessary etiological work up and streamline management.