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Attacked and Shaken by a Dog: A Cause of Traumatic Brain and Carotid Injury in an Infant
Amanda N Stanton1,2, Jamie Toms3, Ann Ritter3
1School of Medicine, Virginia Commonwealth University SOM, Richmond, Virginia, USA, stantona@vcu.edu.
Insights
Large animal attacks, though rare, can cause posttraumatic carotid artery dissection (PTCAD) in infants due to shaking mechanisms. Early imaging like CTA or MRA is crucial for timely diagnosis and treatment.
Area of Science:
- Neurology
- Pediatric Medicine
- Trauma Surgery
Background:
- Posttraumatic carotid artery dissection (PTCAD) typically results from high-energy trauma like motor vehicle accidents.
- Vigorous shaking is an uncommon cause of PTCAD, though it can occur in specific scenarios.
Observation:
- A 7-day-old infant suffered severe head trauma from a large dog attack, presenting with intracranial hemorrhages and neurological deficits similar to shaken baby syndrome (SBS).
- Imaging revealed a Grade IV left internal carotid artery (ICA) dissection, indicating significant vascular injury.
- The infant experienced complications including seizures and retinal hemorrhage, with developmental delays noted at 2-year follow-up.
Findings:
- Large animal attacks represent a rare but potential mechanism for PTCAD in infants.
- The mechanism may involve forceful shaking during the animal attack.
- Vascular imaging, such as CT angiography (CTA) or MR angiography (MRA), should be considered in the initial evaluation of infants with severe head trauma from animal encounters.
Implications:
- Prompt diagnosis of PTCAD is essential for appropriate management and to prevent further neurological damage.
- Considering CTA or MRA in the workup of infants with severe head trauma from dog or large animal attacks can expedite diagnosis.
- Early recognition and intervention may improve outcomes for infants suffering from traumatic vascular injuries.
Background:
Posttraumatic carotid artery dissection (PTCAD) is a common injury in motor vehicle accidents and other extension and rotation injuries, but rarely developed from being shaken vigorously.
Case Description:
A 7-day-old infant presented to our facility after being attacked by a large dog. Initial examination revealed multiple puncture wounds and lacerations with visible dura. Head CT demonstrated subarachnoid, intraparenchymal, and epidural hemorrhages as well as left hemispheric loss of gray-white differentiation. Thus, the patient presented similarly to shaken baby syndrome (SBS). The patient was taken emergently to the operating room for hematoma evacuation and dural repair. Postoperatively, worsened left hemispheric ischemia was noted and an MRA demonstrated a Grade IV left ICA dissection. No intervention, including anticoagulation, was sought as the stroke was determined to be complete with irreversible damage. Hospital course was complicated by worsening exam, seizures, and a retinal hemorrhage. At 2 years follow-up, the patient still has notable delays but is progressing slowly through milestones.
Conclusion:
Large animal attacks are a rare cause of PTCAD but may be due to the mechanism of shaking during the attack. We propose either CTA or MRA be considered as part of the initial workup in cases where an infant is attacked by a dog or other large animals, preventing delay of treatment.
