Wafaa Abougabal/LinkedIn

Feb 16, 2026, 14:53

Wafaa Abougabal: Differential Diagnosis of Acute Neurologic Deficits and Stroke in PICU

Wafaa Abougabal, Head of Pediatrics and PICU department at Ministry of Health and Population of Egypt, shared on LinkedIn:

”Is It Truly Stroke in PICU?

A 9-year-old girl presented with acute right hemiparesis, aphasia, and focal seizure.

MRI: cortical diffusion restriction in the temporo-parietal region.

MRA/MRV: patent vessels.

No thrombocytopenia. No major inflammatory markers.

At first glance: acute arterial ischemic stroke.

But careful analysis showed:

Lesion not confined to a single vascular territory

Mixed ADC pattern

Relative cortical hyperperfusion

Elevated serum lactate

Maternal history of early sensorineural hearing loss

Differential considerations included: Arterial stroke, CVST, TTP, CNS vasculitis, ADEM, CNS infection.

However, absence of vascular occlusion, systemic inflammation, thrombocytopenia, and venous thrombosis shifted the probability.

Final diagnosis: Mitochondrial stroke-like episode (MELAS).

Key learning point:

In pediatric acute focal deficits, diffusion restriction alone does not confirm thromboembolic stroke.

Non-territorial lesions with preserved vessels and metabolic abnormalities mandate consideration of mitochondrial cytopathy.

Avoiding inappropriate thrombolysis can be life-saving.”

Wafaa Abougabal: Differential Diagnosis of Acute Neurologic Deficits and Stroke in PICU

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