Mineralizing Arteriopathy in Infancy Presenting with Multifocal Seizures and Raised Intracranial Pressure: A Case Report

A bstract Pediatric stroke, once considered rare, is now increasingly associated with mineralizing arteriopathy, a poorly understood cause in infants. This case highlights an uncommon presentation, underscoring gaps in understanding its clinical and radiological features. A 4-month-old developmentally normal male presented with excessive crying, irritability, posturing, and multifocal seizures after a fall. Examination revealed generalized hypertonia, brisk reflexes, upgoing plantars, bulging fontanelle, tachycardia, and mild hypoxia; other systems and arterial blood gas were normal. Imaging showed bilateral gangliocapsular and corona radiata subacute infarcts. He received phenytoin, levetiracetam, 3% saline, and aspirin, with brief period of invasive mechanical ventilation and High Dependency Unit care. The child improved and was discharged seizure-free with residual limb hypertonia. The parents were counseled on prevention. Unlike previous presentations, this case of mineralizing arteriopathy stroke presented with multifocal seizures and raised intracranial pressure.