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Traumatic posterior cerebral artery occlusion in a 14-month-old child
Ashish S Kelkar1, Sunil Karande, Vikram Chaudhary
1Division of Pediatric Neurology; Department of Pediatrics; LTM Medical College and LTMG Hospital; Sion; Bombay 400 022, India.
Insights
Head injury in a child caused a basilar artery thrombus, leading to a posterior cerebral artery infarct and persistent eye movement issues. This rare case highlights potential vascular complications following pediatric head trauma.
Area of Science:
- Neurology
- Pediatric Neurology
- Vascular Neurology
Background:
- Head injuries in children can lead to complex neurological complications.
- Posterior cerebral artery territory infarcts are uncommon in young children.
Observation:
- A 14-month-old male developed neck stiffness and bilateral lateral rectus palsies after head trauma.
- Initial imaging showed subarachnoid hemorrhage, cerebral edema, and hydrocephalus.
- A basilar artery mural thrombus was identified, which later resolved.
- A left posterior cerebral artery infarct occurred after thrombus resolution.
Findings:
- The study presents a rare case of a pediatric head injury associated with a basilar artery thrombus.
- The thrombus is postulated to have embolized, causing a posterior cerebral artery territory infarct.
- Bilateral lateral rectus palsies persisted for at least 6 months post-injury.
Implications:
- This case suggests a potential mechanism for posterior cerebral artery infarction following pediatric head trauma.
- It underscores the importance of considering vascular complications in evaluating children with head injuries.
- Further research is needed to understand the incidence and management of such events.
Abstract:
Following a head injury, a 14-month-old male presented with neck stiffness and 24 hours later developed bilateral lateral rectus palsies. An unenhanced cerebral computed tomographic scan performed on admission revealed evidence of subarachnoid hemorrhage, cerebral edema, and mild-to-moderate compensated supratentorial hydrocephalus. A second scan performed 96 hours after the head injury revealed a mural thrombus at the tip of the basilar artery without any evidence of infarction. A third scan performed 12 days later revealed that the thrombus had resolved. However, a left posterior cerebral artery territory infarct was visualized. We postulate that the thrombus had embolized to the left posterior cerebral artery and caused occlusion of its cortical branch and subsequent infarction. A magnetic resonance angiography performed 20 days later excluded any vascular abnormality. The bilateral lateral rectus palsies persisted at the 6-month follow-up. To our knowledge, a head injury leading to a posterior cerebral artery territory infarct has not been reported earlier in a young child.