Cerebral infarct secondary to carotid artery dissection

Dissection of the internal carotid artery is an important cause of ischemic stroke in children and young patients. Trauma and/or an underlying structural defect of the arterial wall have been suggested to be predisposing factors. The typical patient presents with ipsilateral headache or neck pain, ipsilateral Horner's syndrome and delayed ischemic symptoms. Diagnosis is given by ultrasound, transcranial Doppler, magnetic resonance imaging, magnetic resonance angiography and conventional angiography. Treatment of this type of injury includes anticoagulation therapy, antiplatelet therapy and surgery. We report a 14-year-old boy with internal carotid artery dissection who presented with ischemic stroke.     

Congenital horner syndrome and hemiplegia secondary to carotid dissection

A 5-month-old infant had right Horner syndrome and left hemiplegia. Magnetic resonance imaging confirmed smaller cerebral hemisphere and magnetic resonance angiography showed reduced blood flow in the internal carotid artery on the right. A diagnosis of congenital hemiplegia and carotid occlusion secondary to maternal trauma during pregnancy was made.     

Traumatic dissection of the internal carotid artery

We present the case of an 11-year-old male who had a dissection of his left internal carotid artery following a rather innocuous mechanism of injury. Although this phenomenon is documented in the medical literature, it remains a relatively rare event following blunt injury to the head and neck (0.3% occurrence rate in 1 study spanning 7 years). (Despite its rarity, it remains an important cause of cerebrovascular accidents in children. 2) Children presenting with gross neurologic abnormalities following blunt trauma to the head or neck should be considered to have sustained injury to the carotid arteries until proven otherwise.     

Trauma-induced extracranial internal carotid artery dissection leading to multiple infarcts in a young girl

Carotid artery dissections (CADs) represent an uncommon clinical condition that should be considered in the differential diagnosis of young individuals presenting with symptoms of stroke. The basic pathological changes in CAD include a disruption in the media or intima of arterial wall, through which the affected vasculature is predisposed to aneurysm or stenosis, and subsequent stroke. Carotid artery dissection may occur spontaneously or result from trauma, an underlying arteriopathic condition, or predisposing risk factors. The heterogeneous clinical presentations of CAD represent significant diagnostic difficulties, which often lead to delays in diagnosis and treatment. Further complicating the clinical picture is the lack of consensus regarding effective treatment modalities. Because of the often-subtle findings present in CAD, the treating physician must have a high index of suspicion to accurately diagnose and manage the condition. We report extracranial internal CAD in a 17-year-old girl leading to multiple infarcts that was successfully managed with initial antiplatelet therapy and subsequent anticoagulation.     

Arterial infarction caused by carotid artery dissection in the neonate.

Arterial stroke in a neonate caused by carotid artery dissection is rare. We report two cases, one with dissection at the level of the skull base, one just distal to the carotid bulb. Non-invasive techniques like MR angiography and sonography demonstrated the dissection accurately. MR imaging, especially the diffusion-weighted images, showed the extension and site of the cerebral infarction. In one case dissection could be suspected following vacuum and forceps extraction. In the other no obvious birth trauma was reported. In conclusion, in a neonate with clinical signs suggestive of cerebral infarction, dissection of the carotid artery should be considered.     

Internal carotid artery dissection following wooden arrow injury to the posterior pharynx. Case report

In this report the authors describe a case of internal carotid artery (ICA) dissection following a blunt posterior pharynx injury and review current literature on the identification and treatment of such disorders. An ICA dissection developed in a 6-year-old boy who had suffered blunt injury to the posterior pharynx and who was followed up via computed tomography (CT) angiography and clinic visits for 6 months. The ICA dissection healed with pseudoaneurysm development and was treated with anticoagulation therapy. The authors searched the January 1996 through March 2007 MEDLINE database by using the Ovid search engine. They requested all English-language articles with the term "carotid dissection." Reference lists from these articles were retrieved and searched for additional relevant sources. The authors found that given its availability and speed of acquisition, CT angiography typically is the preferred initial diagnostic method. Magnetic resonance angiography is usually recommended for follow-up examination especially in pediatric cases. According to the available literature, the current preferred treatment for ICA dissection is anticoagulation.     

Pneumorrhachis secondary to traumatic pneumomediastinum in a child

Pneumorrhachis (air within the spinal canal) is rare, and even more so in the paediatric population. We report a case in a 4-year-old boy that resolved spontaneously on treating the underlying traumatic pneumomediastinum, and discuss the causes, mechanism and implications of this condition.     

Pathological findings of fusiform dilation of the internal carotid artery following radical dissection of a craniopharyngioma

Fusiform dilation of the internal carotid artery (FDICA) after radical resection of a suprasellar craniopharyngioma has been reported. To the authors' knowledge, however, fatal conditions associated with FDICA have not been reported and pathological findings have not been obtained. The authors performed biopsy sampling of the wall of an FDICA for histopathological evaluation and found hyperplastic adventitia. This pathological result strongly supports conclusions from previous reports that FDICA has a low risk of rupture.     

Aortic aneurysm secondary to umbilical artery catheterization

A 14-month-girl presented with an asymptomatic posterior mediastinal mass. She had a history of prematurity, umbilical artery catheterization, and sepsis. The diagnosis of aortic aneurysm was made by dynamic computed tomography. The aneurysm was successfully resected.     

Thrombosis of the internal carotid artery secondary to soft palate injury in children and childhood. Report of two cases

Trauma to the soft palate is a uncommon event during childhood. Stroke following intraoral trauma is also rare, but has been well documented by the current literature as a potentially serious complication. In this article, we report 2 cases of posttraumatic internal carotid artery thrombosis depicted by imaging studies. We discuss pathogenesis, and the literature is reviewed.     

Right internal carotid artery agenesis

Congenital absence of one or both carotid arteries is a rare anomaly. It is usually discovered incidentally by computed tomography, or magnetic resonance imaging of head and neck taken for some other reason. Most of the patients are asymptomatic, although there is a close association of intracranial aneurysms and subarachinoid hemorrhage in many patients. Here we report a case of right internal carotid agenesis in a young female associated with recent onset amnestic syndrome.     

Cerebral infarct in patients with hemorrhagic shock and encephalopathy syndrome

The syndrome of hemorrhagic shock and encephalopathy (HSE) was first described by Levin et al. in 1983 [1] but not until recently has it been considered to be a newly identified devastating disorder [2, 3]. The main features of this syndrome consist of sudden onset of shock, coma, convulsions, coagulopathy, renal and hepatic dysfunction. The mortality rate is very high with surviving patients suffering from severe neurologic sequelae [4]. In review of the literature [1], we did not find any reports of cerebral infarcts. Recently we managed two patients with this syndrome, both of whom had CT scand findings consistent with cerebral infarctions.