Elevated serum lipoprotein(a) as a risk factor for combined intracranial and extracranial artery stenosis in a child with arterial ischemic stroke: A case report

Rationale: Stroke is an uncommon disease in childhood with an estimated incidence of 1 to 6 per 100,000 and stenoocclusive arteriopathy is the main risk factor of recurrent pediatric arterial ischemic stroke (AIS). Dyslipidemia may influence strongly before puberty and in late adolescence when plasma levels are naturally highest. Patient concerns: An 11-year-old male presented with acute onset seizure, a drowsy mentality, and right hemiplegia. Diagnoses: Magnetic resonance (MR) angiogram demonstrated occlusion of distal basilar artery and left vertebral arteries. Serum Lp(a) was significantly increased as 269-nmol/L (normal<75-nmol/L) only. Thus, he was diagnosed as pediatric AIS. Interventions: He was started on aspirin (100-mg/day) for secondary stroke prevention and received nicotinic acid (2-g/day) as a Lp(a)-lowering agent. Outcomes: Consciousness gradually improved and the patient regained a normal orientation after 2 weeks. The Lp(a) level was reduced to 48-nmol/L after nicotinic acid administration. Lessons: High Lp(a) level may be considered in the risk profile assessment of pediatric AIS. Niacin and certain inhibitors of cholesteryl ester transfer protein can be considered to reduce Lp(a).