{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T14:40:18Z","timestamp":1756305618270,"version":"3.44.0"},"reference-count":13,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,4,25]]},"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:p>Children with Down syndrome have a higher risk of stroke. Similarly, intravenous immunoglobulin (IV Ig) is also known to cause a stroke. We reported a 3-year-old boy with Down syndrome who presented with severe pneumonia and received IV Ig. He developed right hemiparesis 60\u2009hours after the infusion. Blood investigations, echocardiography and carotid Doppler did not suggest vasculitis, thrombophilia or extracranial dissection. Brain computerised tomography (CT) showed acute left frontal and parietal infarcts. Initial magnetic resonance angiography (MRA) of cerebral vessels showed short segment attenuations of both proximal middle cerebral arteries and reduction in the calibre of bilateral supraclinoid internal carotid arteries. The boy was treated with enoxaparin and aspirin. He only had partial recovery of the hemiparesis on follow-up. A repeat MRA 13 months later showed parenchymal collateral vessels suggestive of moyamoya disease. We recommend imaging the cerebral vessels in children with a high risk of moyamoya before giving IV Ig.<\/jats:p>","DOI":"10.1136\/bcr-2019-233149","type":"journal-article","created":{"date-parts":[[2020,5,19]],"date-time":"2020-05-19T05:39:53Z","timestamp":1589866793000},"page":"e233149","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Postintravenous immunoglobulin stroke in a toddler with Down syndrome: a diagnostic challenge"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5909-4855","authenticated-orcid":false,"given":"Teck-Hock","family":"Toh","sequence":"first","affiliation":[{"name":"Department of Paediatrics, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia"},{"name":"Clinical Research Centre, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia"},{"name":"Faculty of Medicine, SEGi University, Kota Damansara, Selangor, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Everlyn Coxin","family":"Siew","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia"},{"name":"Faculty of Medicine, SEGi University, Kota Damansara, Selangor, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chae-Hee","family":"Chieng","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia"},{"name":"Faculty of Medicine, SEGi University, Kota Damansara, Selangor, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hussain Imam","family":"Mohd Ismail","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Penang General Hospital, Georgetown, Pulau Pinang, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,5,18]]},"reference":[{"key":"2025082707113760000_13.5.e233149.1","doi-asserted-by":"publisher","DOI":"10.1016\/0887-8994(85)90060-8"},{"key":"2025082707113760000_13.5.e233149.2","doi-asserted-by":"publisher","DOI":"10.3171\/2014.12.PEDS14563"},{"key":"2025082707113760000_13.5.e233149.3","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000068335.01620.9D"},{"key":"2025082707113760000_13.5.e233149.4","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000068334.04500.08"},{"key":"2025082707113760000_13.5.e233149.5","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.44.2.223"},{"key":"2025082707113760000_13.5.e233149.6","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(92)90806-E"},{"key":"2025082707113760000_13.5.e233149.7","doi-asserted-by":"publisher","DOI":"10.1159\/000008040"},{"key":"2025082707113760000_13.5.e233149.8","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/S0140-6736(86)92511-0","article-title":"Fatal 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