A 16-year-old girl who developed a stroke after a 5-year history of polyarticular juvenile rheumatoid arthritis is reported from Tripler Army Medical Center, Honolulu, Hawaii. She was referred from Chuuk State, Micronesia, because of right hemiparesis, facial weakness, joint pains, and cataract. MR angiography revealed vasculitis of the anterior and middle cerebral arteries. Both clinical and MR findings improved following treatment with methylprenisolone. Outpatient treatment with oral methotrexate, predisone, and aspirin resulted in complete remission. [1]
COMMENT. Juvenile rheumatoid arthritis is an unusual cause of cerebral vasculitis and stroke in children. Cerebral vein thrombosis (CVT) and infarct associated with systemic lupus erythematosus (SLE) is reviewed in Progress in Pediatric Neurology III, PNB Publ, 1997;pl73. Three girls with SLE and CVT, ages 11, 14, and 17, presented with a severe, persistent throbbing headache, unresponsive to analgesics.