Abstract
Due to its rarity, high-quality evidence regarding mechanical thrombectomy for pediatric acute ischemic stroke remains limited. Mycoplasma pneumoniae is a common cause of community-acquired pneumonia in children, and a recognized but uncommon cause of pediatric ischemic stroke. Reports describing large-vessel occlusion associated with M. pneumoniae infection are rare, and the role of mechanical thrombectomy in this setting remains unclear. A 5-year-old boy hospitalized for pneumonia developed a sudden onset of impaired consciousness and quadriplegia. Brain MRI demonstrated acute infarctions involving the brainstem and left cerebellar hemisphere, and MRA revealed vertebrobasilar artery occlusion. Mechanical thrombectomy using contact aspiration and a combined technique resulted in successful reperfusion (modified Thrombolysis in Cerebral Infarction score 2b) with retrieval of red thrombi. Subsequent investigations confirmed M. pneumoniae pneumonia, and an extensive evaluation failed to identify an alternative embolic source. These findings, together with the coagulation abnormalities observed during the acute phase, suggested that the ischemic stroke was most likely caused by thromboembolism associated with M. pneumoniae infection. Despite requiring decompressive craniectomy and intensive care, the patient achieved a favorable neurological outcome, with the modified Rankin Scale score improving from 3 at discharge to 1 at the 3-month follow-up. This case highlights the feasibility and potential efficacy of mechanical thrombectomy in selected pediatric patients with acute ischemic stroke, even in the setting of rare etiologies such as M. pneumoniae infection.