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Published on: July 9, 2020
Carotid artery dissection following a minor household accident in a 10-month-old child
J M Moriarty1, C Lukas, L Rossler
1Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland. jonnymoriarty@yahoo.com
Insights
Minor soft palate trauma can cause internal carotid artery (ICA) dissection and stroke in children. Prompt diagnosis is crucial for managing this rare but severe complication.
Area of Science:
- Pediatric Neurology
- Vascular Surgery
Background:
- Carotid artery dissection is a significant cause of ischemic stroke in children.
- Blunt trauma to the soft palate can rarely lead to internal carotid artery (ICA) dissection, resulting in thrombosis, embolism, and stroke.
Observation:
- A 10-month-old infant sustained minor intra-oral trauma from a fall while holding a spoon.
- Following a symptom-free interval, the child experienced decreased consciousness.
- Cranial imaging revealed left ICA occlusion, perivascular edema, and cerebral ischemia.
Findings:
- The case highlights a rare instance of internal carotid artery dissection secondary to minor soft palate trauma in an infant.
- Imaging confirmed arterial occlusion and subsequent cerebral ischemia.
Implications:
- This case underscores the potential for severe neurological complications from seemingly minor oral trauma in children.
- The diagnostic challenge in young children, due to delayed symptoms and assessment difficulties, necessitates high clinical suspicion for carotid dissection.
Introduction:
Dissection of the carotid arteries is an important cause of ischaemic stroke in childhood. Rarely, blunt trauma to the soft palate can result in an internal carotid artery (ICA) dissection leading to thrombosis, embolism and stroke.
Case Presentation:
A 10-month-old child was admitted to hospital having presented with minor intra-oral trauma following a fall from a sofa whilst carrying a spoon in her mouth. After an interval, the child's level of consciousness decreased. Computed tomography and magnetic resonance imaging of the brain and neck revealed occlusion of the left ICA, oedema of the perivascular tissues and cerebral ischaemia in the left middle cerebral artery territory.
Conclusion:
A carotid artery dissection after minor trauma to the soft palate is a rare, but potentially severe complication. The combination of minor precipitating trauma, prolonged symptom-free intervals and complexity of clinical neurological assessment in small children contributes to a difficult diagnostic dilemma.
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