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Boyraz M, Yüce S, Örmeci MT, Botan E. Thrombosis secondary to penetration of internal carotid artery due to soft palate impalement injury: A case report of hemiplegic syndrome and literature review. Int J Pediatr Otorhinolaryngol 2024; 176:111809. [PMID: 38096745 DOI: 10.1016/j.ijporl.2023.111809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/22/2023] [Accepted: 11/25/2023] [Indexed: 01/08/2024]
Abstract
Intraoral injuries are frequently encountered in emergency departments due to children's desire and curiosity to put objects in their mouths. However, forward falls with objects in children's mouths can cause impalement injuries to soft palate, retropharyngeal-peritonsillar, and retromolar tissues, leading to serious morbidity and even mortality. These transoral (soft palate, pharynx-tonsil, retromolar region) penetration injuries can especially result in damage to major vascular structures like the Internal Carotid Artery (ICA) due to their close proximity. Dissection, thrombosis, and subsequent stroke can occur in the delicate ICA as a result. In the presented case, a 3-year-old male child experienced internal carotid artery dissection following penetrating injury with a pen, as demonstrated by imaging studies. A literature review is provided along with the case of this child, who developed a reduction in middle cerebral artery (MCA) flow due to thrombosis in the ICA. The study encompasses all penetrating oropharyngeal traumas reported in individuals aged 0-18 years from 1936 to 2023. A search in PubMed and Google Scholar using keywords such as 'internal carotid artery injury,' 'penetrating trauma,' and 'children' yielded 78 case reports from a pool of 36,000 studies. The analysis excludes injuries in areas like tongue, cheek, gums, lips, and floor of the mouth, post-tonsillectomy injuries, and those from sudden braking vehicles. This review encompasses the evaluation, diagnosis, and treatment of penetrating injuries to the soft palate, pharyngeal wall, tonsil, and retromolar regions.
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Affiliation(s)
- Merve Boyraz
- TR Health Sciences University, Van Training and Research Hospital, Department of Pediatrics, Türkiye
| | - Servet Yüce
- Istanbul University, Istanbul Faculty of Medicine, Department of Public Health, Türkiye.
| | - Mehmet Tolgahan Örmeci
- TR Health Sciences University, Van Training and Research Hospital, Department of Radiology, Türkiye
| | - Edin Botan
- TR Health Sciences University, Van Training and Research Hospital, Pediatric Intensive Care Unit, Türkiye
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2
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Goktas OA, Bektas O, Yıldırım M, Sahap SK, Yuksel MF, Sahın S, Fıtoz OS, Teber ST. Clinical and Imaging Clues of Arteriopathy-Related Pediatric Arterial Ischemic Stroke: A Single Center Experience. Ann Indian Acad Neurol 2023; 26:917-926. [PMID: 38229616 PMCID: PMC10789414 DOI: 10.4103/aian.aian_315_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/25/2023] [Accepted: 07/15/2023] [Indexed: 01/18/2024] Open
Abstract
Background and Purpose Arteriopathy is a common etiology for childhood arterial ischemic stroke (AIS). In this study, we aimed to address clinical, demographic, and neuroimaging characteristics and the reversibility of vasculopathy in patients with childhood stroke due to arteriopathy by classifying them according to Childhood AIS Standardized Classification and Diagnostic Evaluation (CASCADE) criteria. Methods We included 15 patients with AIS due to arteriopathy presented between 2013 and 2018. All patients were diagnosed and followed up using magnetic resonance imaging (MRI) studies. All acute AIS patients were classified by acute CASCADE criteria (1-4). Moreover, each group was categorized according to the chronic CASCADE criteria, including progressive, stable, reversible, and indeterminate courses. Results In the study population, CASCADE 2 patients were the most common group, and basal ganglia involvement was the most common involvement in CASCADE 2 patients. Of CASCADE 2 patients, 71.4% received steroids, which was compatible with a favorable outcome. In the study, trauma was present in 33.3% of patients, 60% of which was related to CASCADE 4. In the control visit on month 24, there were neuromotor sequelae of 60%, including hemiparesis, facial paralysis, and decreased fine motor skills; furthermore, the recurrence rate was 20%. Conclusion We strongly emphasize that arteriopathy should be kept in mind in school-age children presenting with hemiparesis and headache. Moyamoya disease must be considered in the differential diagnosis with anterior circulation involvement, while focal cerebral arteriopathy (FCA) in patients with basal ganglia involvement was detected on MRI and dissection in the patients with a history of head-neck injury. We think that steroids have positive influences on neurologic prognosis in patients with FCA.
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Affiliation(s)
- Ozben Akıncı Goktas
- Department of Pediatrics, Division of Pediatric Neurology, Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Omer Bektas
- Department of Pediatrics, Division of Pediatric Neurology, Ankara University School of Medicine, Ankara, Turkey
| | - Mirac Yıldırım
- Department of Pediatrics, Division of Pediatric Neurology, Ankara University School of Medicine, Ankara, Turkey
| | - Seda Kaynak Sahap
- Department of Pediatric Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Merve Feyza Yuksel
- Department of Pediatrics, Division of Pediatric Neurology, Recep Tayyıp Erdogan Training and Research Hospital, Rize, Turkey
| | - Suleyman Sahın
- Department of Pediatrics, Division of Pediatric Neurology, Ankara University School of Medicine, Ankara, Turkey
| | - Omer Suat Fıtoz
- Department of Pediatric Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Serap Tıraş Teber
- Department of Pediatrics, Division of Pediatric Neurology, Ankara University School of Medicine, Ankara, Turkey
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3
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Okamoto A, Kawaraguchi Y, Fujita M, Goto Y, Shimokawa M. Accidental retropharyngeal dissection extending close to the right common carotid artery during nasotracheal intubation: a case report. JA Clin Rep 2023; 9:11. [PMID: 36849613 PMCID: PMC9971412 DOI: 10.1186/s40981-023-00603-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/04/2023] [Accepted: 02/17/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Retropharyngeal dissection is a possible complication during nasotracheal intubation. We report a case of a retropharyngeal dissection extending close to the right common carotid artery occurring while inserting a nasotracheal tube. CASE PRESENTATION An 81-year-old woman, scheduled for laparoscopic and endoscopic cooperative surgery for a duodenal tumor under general anesthesia, sustained submucosal dissection of the retropharyngeal space during nasotracheal intubation. Postoperative computed tomography revealed retropharyngeal tissue injury extending close to the right common carotid artery. The patient was treated with prophylactic antibiotic therapy and discharged uneventfully on postoperative day 13. CONCLUSIONS Submucosal dissection of the retropharyngeal tissue during nasotracheal intubation has a potential risk of major cervical vessel injury. Therefore, when the tip of the tube cannot be visualized within the oropharynx, clinicians must proceed with caution regarding the expected depth of the tube.
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Affiliation(s)
- Aki Okamoto
- Department of Anesthesiology, Nara City Hospital, 1-50-1 Higashikidera-cho, Nara-shi, Nara, 635-0833, Japan.
| | - Yoshitaka Kawaraguchi
- grid.416484.b0000 0004 0647 5533Department of Anesthesiology, Nara City Hospital, 1-50-1 Higashikidera-cho, Nara-shi, Nara, 635-0833 Japan
| | - Masahide Fujita
- grid.416484.b0000 0004 0647 5533Department of Anesthesiology, Nara City Hospital, 1-50-1 Higashikidera-cho, Nara-shi, Nara, 635-0833 Japan
| | - Yasunobu Goto
- grid.416484.b0000 0004 0647 5533Department of Intensive Care, Nara City Hospital, 1-50-1 Higashikidera-cho, Nara-shi, Nara, 635-0833 Japan
| | - Mitsuru Shimokawa
- grid.416484.b0000 0004 0647 5533Department of Anesthesiology, Nara City Hospital, 1-50-1 Higashikidera-cho, Nara-shi, Nara, 635-0833 Japan
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4
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Poupore NS, Jungbauer WN, Nguyen SA, White DR, Pecha PP, Carroll WW. The Utility of CTA in Pediatric Oropharyngeal Trauma: A Systematic Review and Meta-Analysis. Laryngoscope 2023; 133:25-37. [PMID: 35394644 DOI: 10.1002/lary.30133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/17/2022] [Accepted: 03/25/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE(S) To analyze the utility of computed tomography angiography (CTA) in identifying internal carotid artery (ICA) injury and reducing cerebrovascular accident (CVA) incidence in children presenting with normal neurologic exams after oropharyngeal trauma (OT). DATA SOURCES PubMed, Scopus, CINAHL, and Cochrane. REVIEW METHODS A systematic review and meta-analysis were performed following PRISMA guidelines. Of 1,185 studies screened, 95 studies of pediatric OT met inclusion criteria. Meta-analysis of proportions was performed. RESULTS A total of 1224 children with OT were analyzed. Excluding case reports, the weighted proportion of a CVA after OT was 0.31% (95% CI 0.06-0.93). If a child presented without neurologic deficits, 0.30% (95% CI 0.05-0.95) returned with new neurologic deficits. An ICA injury was identified in 0.89% (95% CI 0.16-2.74) of screening CTAs. No difference in CVA incidence was seen in children with screening CTA (0.52% [95% CI 0.02-2.15]) compared to children without screening CTA (0.42% [95% CI 0.06-1.37]). Patients who developed CVA had a higher proportion of injuries >2 cm, injuries at the posterior pillar or tonsil, and injuries with a writing utensil or popsicle stick compared to patients without CVA. CONCLUSION The proportion of children experiencing an ICA injury leading to CVA after sustaining OT is low. CTAs infrequently show ICA changes in children with normal neurological exams. Children who receive CTAs do not have a significantly lower incidence of CVAs than children who do not receive CTAs. Clinicians should weigh the risks and benefits of a CTA based on an individual child's presentation and discuss this with caregivers for shared decision-making. Laryngoscope, 133:25-37, 2023.
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Affiliation(s)
- Nicolas S Poupore
- Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina, U.S.A
| | - W Nicholas Jungbauer
- Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
- University of Minnesota Medical School, Minneapolis, Minnesota, U.S.A
| | - Shaun A Nguyen
- Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - David R White
- Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Phayvanh P Pecha
- Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - William W Carroll
- Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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5
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Hankey PB, Cramer E, Tracy M, Zinkus TP, Brown JR. Internal carotid artery position to characterize risk for vessel injury in pediatric intraoral trauma. Int J Pediatr Otorhinolaryngol 2023; 164:111381. [PMID: 36434884 DOI: 10.1016/j.ijporl.2022.111381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/30/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The internal carotid artery (ICA) lies in close anatomic proximity to the oropharynx and is at risk for injury in the instance of intraoral trauma. The objectives of this study are to describe the position of the ICA relative to the oropharynx and identify patient risk factors related to its position. METHODS A total of 100 patients aged 12 months to 7 years 11 months who received computed tomography (CT) of the neck were randomly selected. The position of the ICA was determined by measuring its angular location relative to the center of the oropharynx (ICA angle) and the shortest distance from the oropharyngeal surface (OP-ICA distance). RESULTS Indication for imaging was controlled for in all reported data. Patient age was related to ICA angles on both the left (F = 8.06; P = 0.01; η2 = 0.08, 95% CI: 0.01-0.19) and right (F = 18.62; P < 0.001; η2 = 0.17, 95% CI: 0.05-0.29). Patient weight also was related to ICA angles on both the left (F = 7.08; P = 0.01; η2 = 0.07, 95% CI: 0.01-0.18) and right (F = 11.86; P < 0.001; η2 = 0.11, 95% CI: 0.02-0.24). Patient age was related to the left OP-ICA distance (F = 7.36; P = 0.01; η2 = 0.07, 95% CI: 0.01-0.19), as was patient weight (F = 4.82; P = 0.03; η2 = 0.05, 95% CI: 0.00-0.15). Across all measurements, no significant relationship was identified between ICA position and other patient variables, including sex and race/ethnicity. CONCLUSION The ICA of younger patients and those with lower body weight may be located more medially within the neck and closer to the oropharyngeal surface. This vessel position may place these children at greater anatomic susceptibility for ICA injury in the event of intraoral trauma.
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Affiliation(s)
- Paul Bryan Hankey
- Kansas City University College of Osteopathic Medicine, Kansas City, MO, USA; Children's Mercy Hospital and Clinics, Department of Otolaryngology, Kansas City, MO, USA
| | - Emily Cramer
- Children's Mercy Hospital and Clinics, Department of Otolaryngology, Kansas City, MO, USA
| | - Meghan Tracy
- Children's Mercy Hospital and Clinics, Department of Otolaryngology, Kansas City, MO, USA
| | - Timothy P Zinkus
- Children's Mercy Hospital and Clinics, Department of Radiology, Kansas City, MO, USA
| | - Jason R Brown
- Children's Mercy Hospital and Clinics, Department of Otolaryngology, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
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Maiese A, Frati P, Manetti AC, De Matteis A, Di Paolo M, La Russa R, Turillazzi E, Frati A, Fineschi V. Traumatic Internal Carotid Artery Injuries: Do We Need a Screening Strategy? Literature Review, Case Report, and Forensic Evaluation. Curr Neuropharmacol 2022; 20:1752-1773. [PMID: 34254918 PMCID: PMC9881067 DOI: 10.2174/1570159x19666210712125929] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/05/2021] [Accepted: 06/01/2021] [Indexed: 11/22/2022] Open
Abstract
Internal carotid artery dissection (ICAD) represents the cause of ictus cerebri in about 20% of all cases of cerebral infarction among the young adult population. ICAD could involve the extracranial and intracranial internal carotid artery (ICA). It could be spontaneous (SICAD) or traumatic (TICAD). It has been estimated that carotid injuries could complicate the 0,32% of cases of general blunt trauma and the percentage seems to be higher in cases of severe multiple traumas. TICAD is diagnosed when neurological symptoms have already occurred, and it could have devastating consequences, from permanent neurological impairment to death. Thus, even if it is a rare condition, a prompt diagnosis is essential. There are no specific guidelines regarding TICAD screening. Nevertheless, TICAD should be taken into consideration when a young adult or middle-aged patient presents after severe blunt trauma. Understanding which kind of traumatic event is most associated with TICAD could help clinicians to direct their diagnostic process. Herein, a review of the literature concerning TICAD has been carried out to highlight its correlation with specific traumatic events. TICAD is mostly correlated to motor vehicle accidents (94/227), specifically to car accidents (39/94), and to direct or indirect head and cervical trauma (76/227). As well, a case report is presented to discuss TICAD forensic implications.
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Affiliation(s)
- Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy; ,IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy;
| | - Paola Frati
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy;
| | - Alice Chiara Manetti
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy;
| | - Alessandra De Matteis
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy;
| | - Marco Di Paolo
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy;
| | - Raffaele La Russa
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy;
| | - Emanuela Turillazzi
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy;
| | - Alessandro Frati
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Neurosurgery Division, Human Neurosciences Department, Sapienza University of Rome, Rome, Italy
| | - Vittorio Fineschi
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy; ,Address correspondence to this author at the Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy; E-mail:
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7
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Hon K, Roach D, Dawson J. A case report of blunt intraoral cerebrovascular injury in a child following intraoral trauma: The pen is mightier than the sword. Trauma Case Rep 2022; 37:100567. [PMID: 34988277 PMCID: PMC8693459 DOI: 10.1016/j.tcr.2021.100567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2021] [Indexed: 11/21/2022] Open
Abstract
Carotid artery dissection in the paediatric population is uncommon and in rare cases it can be due to intraoral blunt trauma associated with a stick-like object such as pen or chopstick in the mouth at the time of injury. Given the rarity of the condition, there is significant knowledge gap in evidence-based diagnosis and management of paediatric blunt cerebrovascular injury (BCVI). This case report presents a rare case of asymptomatic carotid artery dissection due to intraoral blunt trauma in a young patient and the successful conservative management. This report also demonstrated the sonographic progression of the carotid artery dissection on follow up imaging.
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Affiliation(s)
- Kay Hon
- Department of Vascular & Endovascular Surgery, Royal Adelaide Hospital, South Australia, Australia.,Faculty of Health & Medical Sciences, The University of Adelaide, South Australia, Australia
| | - Denise Roach
- Faculty of Health & Medical Sciences, The University of Adelaide, South Australia, Australia.,South Australia Medical Imaging, Central Adelaide Local Health Network, South Australia, Australia
| | - Joseph Dawson
- Department of Vascular & Endovascular Surgery, Royal Adelaide Hospital, South Australia, Australia.,South Australia Medical Imaging, Central Adelaide Local Health Network, South Australia, Australia.,Trauma Surgery Unit, Royal Adelaide Hospital, South Australia, Australia
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8
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Lodhia J, Chipongo H, Sadiq A, Khelef K, Bosco K, Dekker M. An Unusual Cause of Cerebral Infarction in a Tanzanian School Child. Child Neurol Open 2022; 9:2329048X221139411. [PMID: 36407557 PMCID: PMC9666708 DOI: 10.1177/2329048x221139411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 10/09/2022] [Accepted: 10/27/2022] [Indexed: 02/15/2024] Open
Abstract
Pediatric stroke is uncommon. A traumatic cause of pediatric ischemic stroke is even rarer. Ischemic stroke due to intraluminal thrombus can be acutely treated with thrombolysis but various factors in sub-Saharan Africa make this unfeasible. We present a case of an eight-year-old Tanzanian boy who sustained penetrating trauma to his palate developing an ischemic stroke of his right middle cerebral artery territory.
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Affiliation(s)
- Jay Lodhia
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P.O Box 3010, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, P. O Box 2240, Moshi, Tanzania
| | - Hilary Chipongo
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P.O Box 3010, Moshi, Tanzania
| | - Adnan Sadiq
- Faculty of Medicine, Kilimanjaro Christian Medical University College, P. O Box 2240, Moshi, Tanzania
- Department of Radiology, Kilimanjaro Christian Medical Centre, P.O Box 3010, Moshi, Tanzania
| | - Khadija Khelef
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, P.O Box 3010, Moshi, Tanzania
| | - Kenan Bosco
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P.O Box 3010, Moshi, Tanzania
| | - Marieke Dekker
- Faculty of Medicine, Kilimanjaro Christian Medical University College, P. O Box 2240, Moshi, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, P.O Box 3010, Moshi, Tanzania
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9
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Internal Carotid Dissection as the Cause of Stroke in Childhood. Case Rep Pediatr 2021; 2021:5568827. [PMID: 34258095 PMCID: PMC8261171 DOI: 10.1155/2021/5568827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/21/2021] [Indexed: 11/17/2022] Open
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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10
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McCollum N, Guse S. Neck Trauma: Cervical Spine, Seatbelt Sign, and Penetrating Palate Injuries. Emerg Med Clin North Am 2021; 39:573-588. [PMID: 34215403 DOI: 10.1016/j.emc.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Pediatric cervical spine, blunt cerebrovascular, and penetrating palate injuries are rare but potentially life-threatening injuries that demand immediate stabilization and treatment. Balancing the risk of a missed injury with radiation exposure and the need for sedation is critical in evaluating children for these injuries. Unfortunately, effective clinical decision tools used in adult trauma cannot be uniformly applied to children. Careful risk stratification based on history, mechanism and examination is imperative to evaluate these injuries judiciously in the pediatric population. This article presents a review of the most up-to-date literature on pediatric neck trauma.
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Affiliation(s)
- Nichole McCollum
- Division of Emergency Medicine, Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, USA.
| | - Sabrina Guse
- Division of Emergency Medicine, Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, USA; George Washington School of Medicine and Health Sciences, 2300 I St NW, Washington, DC 20052, USA
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11
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Sofoluke N, Shimony N, Goren O. Endovascular Treatment of Traumatic Transection of the Vertebral Artery Caused by Penetrating Injury to the Oropharynx in a Pediatric Patient. World Neurosurg 2020; 137:389-392. [PMID: 32084620 DOI: 10.1016/j.wneu.2020.02.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pediatric isolated penetrating traumatic vertebral artery injuries require urgent multidisciplinary management as they may lead to potentially fatal posterior circulation ischemia. CASE DESCRIPTION We present a 19-month-old patient with an isolated penetrating vertebral artery injuries at the V2 segment of the right vertebral artery and report our strategy for her endovascular treatment which involved simultaneous coil embolization and foreign body removal. CONCLUSION Endovascular treatment can be considered first line treatment of oral penetrating injuries to the vertebral artery, where the penetrating object has an anterior to posterior trajectory.
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Affiliation(s)
- Nelson Sofoluke
- Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania, USA.
| | - Nir Shimony
- Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Oded Goren
- Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania, USA
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12
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Carotid Dissection and Cerebral Infarction From Posterior Oropharyngeal Trauma: The Diagnostic and Therapeutic Challenges. Pediatr Emerg Care 2019; 35:e17-e21. [PMID: 30608333 DOI: 10.1097/pec.0000000000001708] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Posterior oropharyngeal trauma commonly occurs in children and frequently presents to the emergency department (ED). Rarely, serious infectious and neurologic sequelae result. Emergency providers are tasked with the challenge of diagnosing the minority with life-threatening complications while maintaining thoughtful stewardship regarding radiation exposure. A previously healthy 2-year-old girl sustained trauma to her posterior oropharynx with a toothbrush that resulted in a left carotid dissection. This dissection was diagnosed in the ED via computed tomography angiogram, Otolaryngology and neurosurgery were consulted in the ED, and anticoagulation therapy was initiated with aspirin. The child did initially well and was without neurologic deficit and no brain ischemia on magnetic resonance imaging. She was discharged home on aspirin therapy. Four days after initial injury, the child returned to the ED after a seizure. Computed tomography scan of the head demonstrated infarction at the junction of the left parietal and temporal areas. Although neurologic complications are rare, posterior oropharyngeal trauma in children is not. There are many diagnostic and therapeutic challenges in its management. This case is, to the authors' awareness, the first case report in the English literature of a known and treated carotid dissection in a child after posterior oropharyngeal trauma that resulted in stroke despite diagnosis and initiation of treatment. The diagnostic and therapeutic challenges of posterior oropharyngeal trauma in children are discussed in this article.
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13
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Cebeci D, Arhan E, Demir E, Uçar M, Uçar HK, Serdaroğlu A, Öztürk Z. Internal carotid artery dissection without intracranial infarct following a minor shoulder trauma: The second pediatric case and review of the literature. J Clin Neurosci 2018; 56:172-175. [PMID: 30041901 DOI: 10.1016/j.jocn.2018.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 07/08/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Carotid artery dissections may occur in severe trauma such as motor vehicle accidents or may also develop due to minor trauma. We aimed to present a case with internal carotid artery dissection that referred to the pediatric neurology department due to speech impairment after minor shoulder trauma. CASE A previously healthy 10-year-old male patient was admitted to the pediatric emergency clinic due to headache, vomiting and speech impairment. In his story, we learned that he had bumped shoulder to shoulder with his friend about 6 h ago. He did not fall or hit his head. On his admission he could not speak and had right central facial paralysis. There was no infarct or diffusion limitation in MRI but MR angiography showed thinning in left internal carotid artery calibration. Fat-suppressed, non-contrast T1-weighted MRI showed that the left carotid artery had ring-shaped pathological signal changes. Low-molecular-weight heparin therapy was initiated with the diagnosis of carotid artery dissection (CAD). No hemiparesis or hemiplejia occurred in the follow-up of the patient. Within a few days, his speech improved. At the end of the first month, facial paralysis completely recovered. CONCLUSION In carotid artery dissections, prodromal symptoms such as transient ischemic attack, like in our patient, are rarely present in children. For good long term outcomes, it is very important to suspect, diagnose and initiate appropriate treatment in a rapid manner in carotid artery dissection before severe neurological findings such as acute ischemic stroke develops.
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Affiliation(s)
- Dilek Cebeci
- Department of Pediatric Neurology, Gazi University Faculty of Medicine, 10th Floor Besevler, Ankara, Turkey.
| | - Ebru Arhan
- Department of Pediatric Neurology, Gazi University Faculty of Medicine, 10th Floor Besevler, Ankara, Turkey
| | - Ercan Demir
- Department of Pediatric Neurology, Gazi University Faculty of Medicine, 10th Floor Besevler, Ankara, Turkey
| | - Murat Uçar
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Habibe Koç Uçar
- Department of Pediatric Neurology, Gazi University Faculty of Medicine, 10th Floor Besevler, Ankara, Turkey
| | - Ayşe Serdaroğlu
- Department of Pediatric Neurology, Gazi University Faculty of Medicine, 10th Floor Besevler, Ankara, Turkey
| | - Zeynep Öztürk
- Department of Pediatric Neurology, Gazi University Faculty of Medicine, 10th Floor Besevler, Ankara, Turkey
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Pham Q, Lentner M, Hu A. Soft Palate Injuries During Orotracheal Intubation With the Videolaryngoscope. Ann Otol Rhinol Laryngol 2016; 126:132-137. [PMID: 27831515 DOI: 10.1177/0003489416678008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The videolaryngoscope has gained popularity for providing superior visualization in intubations. A rare complication of this technology is soft palate injury. Through a literature review and case series, we highlight the risks associated with the Glidescope and McGrath videolaryngoscopes and the management of soft palate injuries. METHOD A case series of multi-institutional review of medical records was performed to identify patients with soft palate injuries from the videolaryngoscope. A literature review was also performed to analyze risk factors, mechanism of injury, complications, and management of palate injuries. RESULTS Of 9 cases, 3 resulted in soft palate perforations, which required primary closure. The remaining 6 patients sustained a soft palate laceration, which was treated conservatively. This injury commonly occurs when the intubator is focused on the video monitor and blindly inserts the Glidescope into the oropharynx. The rigid stylet used with the Glidescope increases the propensity for oropharyngeal injuries during blind insertions. CONCLUSION Proper training, an awareness of this potential complication, and direct oral cavity visualization are recommended while inserting the videolaryngoscope. Repair is recommended for through-and-through perforations or if a large hanging flap is present. Antibiotics should be considered for lacerations greater than 1 to 2 cm.
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Affiliation(s)
- Quang Pham
- 1 Philadelphia College of Osteopathic Medicine, Otolaryngology-Head & Neck Surgery, Philadelphia, Pennsylvania, USA
| | - Mark Lentner
- 1 Philadelphia College of Osteopathic Medicine, Otolaryngology-Head & Neck Surgery, Philadelphia, Pennsylvania, USA
| | - Amanda Hu
- 2 Drexel University College of Medicine, Otolaryngology-Head & Neck Surgery, Philadelphia, Pennsylvania, USA
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15
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The tin whistle: a rare and serious cause of penetrating oropharyngeal trauma in children. Case Rep Emerg Med 2014; 2014:562418. [PMID: 25197581 PMCID: PMC4147197 DOI: 10.1155/2014/562418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/23/2014] [Indexed: 11/18/2022] Open
Abstract
Impalement injuries of the oral cavity are common in children and the potential for serious complications including internal carotid artery thrombosis can be unnoticed. We present a patient who sustained a penetrating injury in which a "tin whistle" caused herniation of the parotid gland which was not detected on clinical examination. We discuss the challenging clinical examination, the role of investigations, and consequences of these injuries aiming at increasing awareness and optimizing patient management.
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Orman G, Tekes A, Poretti A, Robertson C, Huisman TAGM. Posttraumatic carotid artery dissection in children: not to be missed! J Neuroimaging 2013; 24:467-72. [PMID: 24251954 DOI: 10.1111/jon.12071] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/01/2013] [Accepted: 07/03/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Gunes Orman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
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Hennelly KE, Fine AM, Jones DT, Porter S. Risks of radiation versus risks from injury: A clinical decision analysis for the management of penetrating palatal trauma in children. Laryngoscope 2013; 123:1279-84. [PMID: 23404330 DOI: 10.1002/lary.23962] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 10/17/2012] [Accepted: 12/06/2012] [Indexed: 11/09/2022]
Affiliation(s)
- Kara E. Hennelly
- Division of Emergency Medicine; Boston Children's Hospital; Boston; Massachusetts
| | - Andrew M. Fine
- Division of Emergency Medicine; Boston Children's Hospital; Boston; Massachusetts
| | - Dwight T. Jones
- Department of Otolaryngology; University of Nebraska Medical Center; Omaha; Nebraska; U.S.A
| | - Stephen Porter
- Division of Pediatric Emergency Medicine; The Hospital for Sick Children; Department of Pediatrics; University of Toronto; Toronto; Ontario; Canada
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Mortazavi MM, Verma K, Tubbs RS, Harrigan M. Pediatric traumatic carotid, vertebral and cerebral artery dissections: a review. Childs Nerv Syst 2011; 27:2045-56. [PMID: 21318614 DOI: 10.1007/s00381-011-1409-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 01/27/2011] [Indexed: 10/18/2022]
Abstract
Traumatic cerebral dissections are rare but potentially dangerous conditions that through improved diagnostics have recently gained increased interest. However, there is still a significant lack of knowledge on the natural history, as well as on the best treatment options. Most of the literature on this topic consists of case reports and retrospective studies with no prospective randomized controlled studies. In our review, we highlight the fact that there is no level 1 evidence for the natural history of cerebral dissections or for the best treatment. We present 26 case studies derived from 70 pediatric patients affected by dissections, occlusions, and pseudoaneurysms.
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Affiliation(s)
- Martin M Mortazavi
- Division of Neurological Surgery, Department of Surgery, University of Alabama, Birmingham, AL, USA
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Hennelly K, Kimia A, Lee L, Jones D, Porter SC. Incidence of morbidity from penetrating palate trauma. Pediatrics 2010; 126:e1578-84. [PMID: 21041279 DOI: 10.1542/peds.2010-1059] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The true rate of neurologic sequelae and infection from penetrating palatal trauma in children is unknown, which leads to significant variation in testing and treatment. OBJECTIVES To (1) determine the incidence of stroke and infection in well-appearing children with penetrating palatal trauma and (2) describe patterns of testing and treatment for uncomplicated palatal trauma. METHODS We assembled a retrospective cohort of children aged 9 months to 18 years with palatal trauma seen in the emergency department (ED) at a tertiary care pediatric hospital. Patients met the following definition: well-appearing with normal neurologic examination and a palate laceration but no findings requiring immediate operative care. Stroke was defined as any abnormal neurologic examination secondary to palatal trauma. Infection was defined as cellulitis or abscess secondary to palatal injury. All abnormal computed tomographic angiography (CTA) findings, except for free air, were considered positive and potentially significant. RESULTS We identified 1656 potential subjects. A total of 995 of 1656 subjects were screened, and 205 of 995 met the case definition. A total of 122 of 205 had follow-up through at least 1 week after injury. The incidence of stroke in our study population was 0% (95% confidence interval [CI]: 0-2.5). One of 116 patients developed infection, for an incidence of 0.9% (95% CI: 0-5.3). A total of 90 of 205 (44%) subjects had CTA scans; the results of 9 (10%) were positive. No patients with positive CTA findings required operative care. No patients received anticoagulant medications. CONCLUSIONS The incidence of morbidity from penetrating palatal trauma in the well-appearing child is extremely low. Diagnostic evaluation in the ED did not prompt clinical interventions other than antibiotics.
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Affiliation(s)
- Kara Hennelly
- Division of Emergency Medicine, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.
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Chamoun RB, Jea A. Traumatic Intracranial and Extracranial Vascular Injuries in Children. Neurosurg Clin N Am 2010; 21:529-42. [DOI: 10.1016/j.nec.2010.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mukhopadhyay S, Iorwerth A. Intercavernous portion of internal carotid artery occlusion resulting from snowboarding. Int Med Case Rep J 2010; 3:31-4. [PMID: 23754884 PMCID: PMC3658215 DOI: 10.2147/imcrj.s8182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 33-year-old gentleman who was otherwise fit and healthy suffered repetitive low impact head injuries while snowboarding in Austria over a period of one week. During the fall he had several hyperextension injuries and presented with headache, nausea, vomiting, drowsiness (felt ‘drunk’ on Friday night despite not being drunk), diplopia, abnormal pupillary signs. A Horner’s syndrome was diagnosed and on investigation, the left intercavernous portion of internal carotid artery (ICA) was found to be thrombosed. The symptoms gradually settled after conservative treatment for a month. Blunt head trauma is a recognized cause of carotid dissection and thrombosis and many neuromechanics studies have attempted to calculate the wall shear stress involved. Physicians treating snowboarders should be aware of the condition and should look for Horner’s syndrome and consider the possibility of carotid occlusion. With a thorough PubMed, Ovid, EMBASE search using ‘snowboarding’, ‘carotid dissection’, ‘Horner’s syndrome’ no such case was found to be reported. Proper training for such sport activities is essential to avoid serious consequences.
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Carotid artery dissection following a minor household accident in a 10-month-old child. Ir J Med Sci 2009; 178:535-9. [PMID: 19543769 DOI: 10.1007/s11845-009-0374-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 05/27/2009] [Indexed: 10/20/2022]
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Chamoun RB, Mawad ME, Whitehead WE, Luerssen TG, Jea A. Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options. J Neurosurg Pediatr 2008; 2:101-8. [PMID: 18671613 DOI: 10.3171/ped/2008/2/8/101] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Currently, no diagnostic or treatment standards exist for extracranial carotid artery dissection (CAD) in children after trauma. The purpose of this study was to review and describe the characteristics, diagnosis, and treatment of this rather uncommon sequelae of pediatric trauma. METHODS A systematic review of the literature was performed to examine the pertinent studies of traumatic extracranial carotid artery (CA) injuries in children. RESULTS No randomized trials were identified; however, 19 case reports or small case series consisting of 34 pediatric patients were found in the literature. The diagnosis of CAD was made in 33 of 34 patients only after the onset of ischemic symptomatology. Twenty-four of 34 patients underwent cerebral angiography to confirm diagnosis; MR angiography affirmed the diagnosis in 6 of 34 patients. There was little published experience with CA ultrasonography or CT angiography for diagnosis. Thirty of 34 patients were treated with medical therapy or observation; 2 of 4 patients treated with observation alone died. There was little experience with open surgical treatment of CAD in the pediatric population, and there were no studies on the endovascular treatment of traumatic CAD in children. The literature does not support anticoagulation therapy over antiplatelet therapy. CONCLUSIONS As a result of this review of the literature, the authors propose the algorithms for the evaluation and treatment of traumatic extracranial CADs in children. These recommendations include utilizing MR angiography as a screening tool in cases in which the clinical suspicion of CAD is high, using conventional cerebral angiography to confirm the diagnosis, implementing antiplatelet therapy as initial medical management, and reserving endovascular stenting in cases of failed medical treatment.
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Affiliation(s)
- Roukoz B Chamoun
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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Lubarsky M, Helmer R, Knight C, Mullins ME. Internal carotid artery dissection following wooden arrow injury to the posterior pharynx. Case report. J Neurosurg Pediatr 2008; 1:334-6. [PMID: 18377312 DOI: 10.3171/ped/2008/1/4/334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this report the authors describe a case of internal carotid artery (ICA) dissection following a blunt posterior pharynx injury and review current literature on the identification and treatment of such disorders. An ICA dissection developed in a 6-year-old boy who had suffered blunt injury to the posterior pharynx and who was followed up via computed tomography (CT) angiography and clinic visits for 6 months. The ICA dissection healed with pseudoaneurysm development and was treated with anticoagulation therapy. The authors searched the January 1996 through March 2007 MEDLINE database by using the Ovid search engine. They requested all English-language articles with the term "carotid dissection." Reference lists from these articles were retrieved and searched for additional relevant sources. The authors found that given its availability and speed of acquisition, CT angiography typically is the preferred initial diagnostic method. Magnetic resonance angiography is usually recommended for follow-up examination especially in pediatric cases. According to the available literature, the current preferred treatment for ICA dissection is anticoagulation.
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Vincent RD, Wimberly MP, Brockwell RC, Magnuson JS. Soft palate perforation during orotracheal intubation facilitated by the GlideScope videolaryngoscope. J Clin Anesth 2007; 19:619-21. [DOI: 10.1016/j.jclinane.2007.03.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 03/26/2007] [Accepted: 03/27/2007] [Indexed: 10/22/2022]
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Abstract
BACKGROUND Oral cavity and oropharyngeal injuries are common among pediatric patients seen in emergency rooms for head and neck trauma. The appropriate treatment of such injuries is often controversial. PATIENTS AND METHODS Audit of 6 months' admissions to the pediatric emergency room in a secondary care referral center. Sixty-four patients were treated for various injuries. Charts were reviewed for relevant data. RESULTS Description of distribution of types and sites of injuries and discussion of treatment recommendations. CONCLUSIONS Most of oropharyngeal injuries heal without any intervention and therefore can be left untreated after being diagnosed. However, in certain injuries, treatment is indicated for better outcome results.
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