Internal carotid artery dissection without intracranial infarct following a minor shoulder trauma: The second pediatric case and review of the literature.

Autor: Cebeci, Dilek, Arhan, Ebru, Demir, Ercan, Uçar, Murat, Uçar, Habibe Koç, Serdaroğlu, Ayşe, Öztürk, Zeynep
Zdroj: Journal of Clinical Neuroscience; Oct2018, Vol. 56, p172-175, 4p
Abstrakt: Highlights • Carotid artery dissections may occur in minor traumas. • Prodromal signs of upcoming AIS like transient ischemic attacks are rare in children. • It is very important to suspect, diagnose and initiate appropriate treatment in CAD. • If not diagnosed early, severe findings such as acute ischemic stroke may occur. • We present a case with internal carotid artery dissection before stroke developed. Abstract Introduction Carotid artery dissections may occur in severe trauma such as motor vehicle accidents or may also develop due to minor trauma. We aimed to present a case with internal carotid artery dissection that referred to the pediatric neurology department due to speech impairment after minor shoulder trauma. Case A previously healthy 10-year-old male patient was admitted to the pediatric emergency clinic due to headache, vomiting and speech impairment. In his story, we learned that he had bumped shoulder to shoulder with his friend about 6 h ago. He did not fall or hit his head. On his admission he could not speak and had right central facial paralysis. There was no infarct or diffusion limitation in MRI but MR angiography showed thinning in left internal carotid artery calibration. Fat-suppressed, non-contrast T1-weighted MRI showed that the left carotid artery had ring-shaped pathological signal changes. Low-molecular-weight heparin therapy was initiated with the diagnosis of carotid artery dissection (CAD). No hemiparesis or hemiplejia occurred in the follow-up of the patient. Within a few days, his speech improved. At the end of the first month, facial paralysis completely recovered. Conclusion In carotid artery dissections, prodromal symptoms such as transient ischemic attack, like in our patient, are rarely present in children. For good long term outcomes, it is very important to suspect, diagnose and initiate appropriate treatment in a rapid manner in carotid artery dissection before severe neurological findings such as acute ischemic stroke develops. [ABSTRACT FROM AUTHOR]
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