Internal Carotid Dissection as the Cause of Stroke in Childhood
Giulia Cinelli1, Vitaliana Loizzo1, Lisa Montanari1
1Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Largo del Pozzo 71-41124, Modena, Italy.
Insights
Internal carotid artery (ICA) dissection can cause pediatric stroke and is often missed. Early suspicion in children with neurological deficits after neck trauma is crucial for timely diagnosis and improved management.
Area of Science:
- Neurology
- Pediatric Stroke
Background:
- Internal carotid artery (ICA) dissection is an underdiagnosed cause of stroke in children.
- Risk factors and pathogenic mechanisms of ICA dissection remain poorly understood.
- Current treatment strategies for pediatric ICA dissection are largely empirical.
Observation:
- A previously healthy 9-year-old girl presented with right hand hypertonic closure, fine motor difficulties, and speech impairment.
- She had a history of minor cervical trauma 20 days prior.
- Neuroimaging revealed ischemic lesions secondary to left ICA dissection.
Findings:
- Treatment with acetylsalicylic acid and levetiracetam led to ICA recanalization.
- Clinical symptoms resolved following treatment.
- This case highlights a potential therapeutic approach for pediatric ICA dissection.
Implications:
- Pediatric ICA dissection should be suspected in children with mild neurological deficits post-cervical trauma, especially with headache or neck pain.
- Early diagnosis and intervention are critical for favorable outcomes.
- Further research is needed to improve the management of pediatric ICA dissection.
Abstract:
Internal carotid artery (ICA) dissection is a cause of stroke, but it is often underdiagnosed in children. ICAs' risk factors and pathogenic mechanisms are poorly understood, and the treatment is still empirical. We report the case of a previously healthy 9-year-old girl who presented with involuntary hypertonic closure of the right hand associated with transient difficulty for both fine movements of the right arm and speech. She had a history of minor cervical trauma occurring 20 days prior to our observation without other associated risk factors. Magnetic resonance imaging and magnetic resonance angiography showed ischemic lesions due to the left ICA dissection. Treatment with both acetylsalicylic acid and levetiracetam allowed recanalization of the ICA associated with the resolution of clinical signs. Our clinical case suggests that the ICA dissection must be suspected early whenever a child manifests mild neurologic deficits after a cervical trauma, especially if they are associated with headache and/or cervical pain. Moreover, the management of ICA dissection must be improved.
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