Abstract 14002: Endovascular Embolization and Coiling for an Intracranial Aneurysm in a 9 - Month Old Infant With Kawasaki Disease- A Unique Case Report

Abstract

Introduction: Cerebrovascular involvement is rare in Kawasaki disease.We present a unique case of such an infant who developed intraventricular haemorrhage and was diagnosed with an intracranial aneurysm. Case Report: A 9-month-old female infant was referred to us with 5 days of high-grade intermittent fever & watery diarrhoea that did not respond to routine care. On arrival, she was stable with WBC count 20,000/UL, CRP 111 mg/L & ESR 85 mm/hr.She continued to have fever spikes and Echocardiography revealed dilated left coronaries with a LAD Z score of +2.92. Hence, by pediatric guidelines, she was started on IVIg (2g/kg) for Kawasaki disease. Repeat echocardiography 2 days later showed reduction in coronary prominence. On Day 10, the child developed episodes of abnormal posturing and respiratory failure. MRI brain showed intraventricular haemorrhage in dependent horns of bilateral lateral, 3rd and 4th ventricles and subarachnoid haemorrhage. CT angiography showed a saccular aneurysm at the junction of V4 segment of right vertebral artery & basilar artery (Figure 1). She underwent endovascular embolization, coiling of aneurysm& omaya reservoir insertion(Figure 2). She was weaned off supportive care & recovered well. Conclusion: Unlike fe existing reports, haemorrhage occurred during active phase of the disease and not years after diagnosis. To our knowledge, this is the first report of endovascular management of aneurysmal subarachnoid haemorrhage in KD in an infant. This uncommon presentation in an infant warrants discussion on whether routine screening of all children suspected of Kawasaki disease for extracardiac aneurysms might be potentially life-saving.