Commentary on Choudhari, et. al., Management of vasospasm-induced stroke after CACNA1A-related hemiplegic migraine


Ratika Srivastava

Department of Pediatrics – Neurology, Alberta Children’s Hospital

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This report nicely describes a common and concerning presentation – that of headache and hemiparesis in an adolescent after concussion or recent physical activity. This is often encountered in the ER andc requires a high degree of clinical acumen to determine whether features are consistent with migraine or stroke or both. Transcranial doppler (TCD) ultrasound provides a non-invasive approach to monitor for vasospasm in patients with known vasculopathies (i.e. sickle cell disease) that have high risk of stroke, as well as in acutely unwell children requiring close bedside monitoring in the intensive care units.

Our experience includes a previously well 6-month-old who developed infectious CNS vasculopathy, where abnormal TCD velocities on routine assessment were the first indication of progressive ischemic injury (unpublished case). The potential for using TCD in pediatric stroke and cerebrovascular conditions has been described (LaRovere 2015) and ICU practice recommendations recently proposed (O’Brien et al 2021). This case further supports the effectiveness and efficiency of TCD in monitoring for vasospasm in pediatric patients at risk of stroke.


LaRovere, Kerri L. Transcranial Doppler ultrasound in children with stroke and cerebrovascular disorders, Current Opinion in Pediatrics: December 2015 – Volume 27 – Issue 6 – p 712-718 doi: 10.1097/MOP.0000000000000282

O’Brien NF, Reuter-Rice K, Wainwright MS, Kaplan SL, Appavu B, Erklauer JC, Ghosh S, Kirschen M, Kozak B, Lidsky K, Lovett ME, Mehollin-Ray AR, Miles DK, Press CA, Simon DW, Tasker RC, LaRovere KL. Practice Recommendations for Transcranial Doppler Ultrasonography in Critically Ill Children in the Pediatric Intensive Care Unit: A Multidisciplinary Expert Consensus Statement. J Pediatr Intensive Care. 2021 Jun;10(2):133-142. doi: 10.1055/s-0040-1715128. Epub 2020 Sep 4. PMID: 33884214; PMCID: PMC8052112

Srivastava Commentary

Pediatr Stroke. 2022;3:37

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