Clinical Letter

Acute Ischemic Stroke in a Pediatric Patient due to Osteosarcoma Embolism

Patient Description

This six-year-old right-handed girl with osteosarcoma of the femur with pulmonary metastasis presented with acute-onset right hemiparesis that began 3.5 hours earlier. Examination revealed right nasolabial fold flattening and reduced movement of her right arm and leg in the plane of the bed. Left-sided strength was intact, and no other deficits were elicited. There was no preceding head trauma or seizures.

Brain magnetic resonance imaging with magnetic resonance angiography showed diffusion

Discussion

Acute ischemic stroke in cancer is often related to an underlying hyperviscous or hypercoagulable state. Tumor embolism is rare and typically caused by cardiac or pulmonary malignancies that invade into a pulmonary vein.^1,2 Most patients with tumor embolism have been adults, but one 29-month-old girl experienced a left middle cerebral artery occlusion from a cardiac myxosarcoma embolus who died due to brainstem herniation and systemic metastases despite undergoing chemotherapy.³

Osteosarcoma is

Notice of Duplicate Publication

Subsequent to the publication of this article, other authors published another description of the same patient’s findings in a different journal (see Troy C, Sisti J, Maldonado-Soto A, Tosto-D’antonio G, Miller ML, Remotti F, Mandigo G. A Case of Pediatric Stroke: Osteosarcoma Embolus in the Internal Carotid Artery, Case Reports in Neurology, DOI: 10.1159/000514089). An investigation by the authors’ institution concluded that the authors were unaware of the Pediatric Neurology article

Acknowledgments

We thank the patient and her family, and the physicians, especially the neuropathologists and neurosurgeons, nurses, and staff involved in her care.