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Published on: August 11, 2015
Decompressive craniectomy for massive internal carotid artery infarction after pediatric penetrating neck trauma
Bruno Miguel Fernandes de Carvalho1, Clara Chamadoira2, Rita Figueiredo3
1Department of Neurosurgery, Centro Hospitalar S. João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. bmfcarvalho@gmail.com.
Insights
Pediatric penetrating neck trauma can cause malignant cerebral infarction. Decompressive hemicraniectomy (DCH) led to impressive recovery in a 4-year-old boy with internal carotid artery (ICA) injury.
Area of Science:
- Neurology
- Pediatric Surgery
- Vascular Surgery
Background:
- Pediatric malignant stroke is rare, and decompressive hemicraniectomy (DCH) benefits are debated.
- Penetrating carotid arterial trauma is an underreported cause of pediatric malignant cerebral infarction.
Observation:
- A 4-year-old boy sustained penetrating zone II neck trauma, lacerating the right internal carotid artery (ICA).
- This injury resulted in malignant cerebral infarction, necessitating DCH.
Findings:
- The patient experienced significant neurological recovery and excellent functional outcomes post-DCH.
- Good psychomotor development and quality of life were observed.
Implications:
- This case highlights DCH as a viable treatment for pediatric malignant ICA infarction due to trauma.
- It suggests favorable outcomes are achievable with timely intervention.
Abstract:
Pediatric penetrating carotid arterial trauma is a rare unreported cause of malignant cerebral infarction. Despite increasing evidence of benefit of decompressive hemicraniectomy (DCH) in pediatric malignant stroke, indications and predictors of outcome remain controversial. We report a 4-year-old boy with penetrating zone II neck trauma with laceration of the right internal carotid artery who developed malignant cerebral infarction requiring DCH. Impressive neurological recovery and excellent functional outcome was observed with good psychomotor development and quality of life. To our knowledge, this is the first reported case of pediatric malignant ICA infarction due to penetrating arterial trauma with good neurologic outcome after DCH.
