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Pediatric blunt carotid injury--case report
Shinya Oshiro1, Hirokazu Ohnishi, Mika Ohta
1Department of Neurosurgery, Sasebo Central Hospital, Sasebo, Nagasaki, Japan. oshiro_shinya@hosp.pref.okinawa.jp
Neurologia Medico-Chirurgica
|April 18, 2003
Summary
A pediatric case of blunt carotid injury presented with a hyperdense middle cerebral artery (MCA) sign on CT, indicating early cerebral ischemia. This sign aided in detecting stroke before focal neurological deficits appeared.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Trauma Surgery
Background:
- Blunt carotid artery injuries in children are rare but can lead to severe neurological deficits.
- Early detection of cerebral ischemia is crucial for timely intervention and improved outcomes.
Observation:
- A 5-year-old boy sustained blunt carotid injury after being struck by a vehicle.
- Initial CT revealed a skull fracture, but no intracranial lesions.
- A repeat CT demonstrated a hyperdense middle cerebral artery (MCA) sign, preceding focal neurological deficits.
Findings:
- The patient developed left hemiparesis 18 hours post-injury, with CT confirming right MCA territory infarction.
- Angiography revealed a right internal carotid artery occlusion with inadequate collateral circulation.
- The hyperdense MCA sign was a key indicator of early cerebral ischemia.
Implications:
- The hyperdense MCA sign is a valuable early marker for detecting cerebral ischemia in pediatric blunt carotid artery injuries.
- Prompt recognition can guide management strategies, even in the absence of overt neurological signs.
- This case highlights the importance of advanced imaging in pediatric trauma to identify subtle but critical vascular injuries.