Posttraumatic carotid artery dissection in children: not to be missed!

Post-traumatic carotid artery dissection (PTCAD) may result in acute arterial ischemic stroke (AIS). Pediatric PTCAD is rarely diagnosed prior to onset of neurological symptoms. We report on neuroimaging findings in a series of children with PTCAD.

Five children with head or neck trauma were included in this study. Clinical histories were reviewed for mechanism of trauma, symptoms, complications, therapy, and outcome. Computed tomography (CT), magnetic resonance imaging (MRI), and CT/MR angiography (CTA, MRA) studies were retrospectively evaluated for signs and complications of PTCAD and presence and extent of skull base fractures.

PTCAD was located at the level of the skull base in all children and was associated with a skull base fracture in two. The diagnosis was made in five children by combined MRI/MRA and in two by CTA. Air in the carotid canal suggested skull base injury with PTCAD in two children. PTCAD was complicated by AIS in three children.

PTCAD may result from neck and head trauma. To avoid secondary AIS, radiologists should be familiar with neuroimaging findings in children, especially as acute PTCAD may initially be clinically silent. Consequently, pediatric neuroradiologists should actively exclude PTCAD in children with head and neck trauma.